HomeMy WebLinkAboutHS202100015 Application 2021-04-22Homestay
Zoning Clearance Application
Submit this completed application with the following online or to the address above:
1.
t/ 2.
Albemarle county
Community Development
401 Mcl ntire Rd., North Wing
r Charlottesville, VA 22902
•H+�' Phone 434.296.5832 1 Fax 434.972.4126
Application fee: $158
Floor plan/property sketch with labeled structures used for the homestay, guest bedrooms, owner's bedroom, outdoor lighting
and signage for the homestay, labeled setbacks, and parking (minimum 2 + 1 spot/guest bedroom).
Copies of two forms of verification of residency (one government issued with photo ID + one listing the address - acceptable forms
include driver's license, voter registration card, U.S. passport, others as approved bythe Zoning Administrator)
1. Homestay Information
Residentially zoned and rural area parcels of less than 5 acres may have 2 guest bedrooms by -right. Use of accessory stmctures Cif built before August 7, 2019) is
ontypermitted by -right on rural area parcels of 5+ acres. Whole house rental is only permitted on rural area parcels of 5+ acres.
ADDRESS:
Z 1 I 3 SW%
S J 'lk\
CITY, STATE, ZIP:
Gl'oze V
2 Z`•1 2
TAX MAP PARCEL (IF KNOWN):
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
�UlX1a.�r1OaS �p It1�1�C ACREAGE OF PARCEL:
Z,g
NO. OF GUEST BEDROOMS:
I
USING ACCESSORY STRUCTURES?
I 2JYE5 ® NO
I WHOLE HOUSE RENTAL?
I ® YES ® NO
2. Property Owner/Operator Information
NAME:
wanwe aQ- 1 y�
HOMEADDRESS:
`_ fLA�1111ite.
'zq 1 5S/�
CITY, STATE, ZIP:
Crozet 224 IF2
PHONE NUMBER:
765. VA. 5vz
EMAIL:
`-
Q`�QY 7�Y� OQ t'�Sll; rley.
3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay at all times during a homestay use, and must respond and attempt in good faith to
resolve any complaints within 60 minutes of being contacted.
NAME:
HOME ADDRESS:
Z� 1 �f ),, 1 e�4-l's M11 d
CITY, STATE, ZIP:
�` �'Z„e"�'' J-z z q 3 Z
PHONE NUMBER:
70$ -19(Q4 - 2312-
EMAIL:
`_
rr
(l e,'(Q,y�tl '� -jWl lieV
4.Signature
I hereby apply for approval to conduct the homestay identified above, and certify that this address is my legal residence, and that I own
the property or that I have recieved a special exception to operate the homestay as a resident manager. I also certify that I have read the
restrictions on homestays, that I understand them, and that I will abide by them.
SIGNATURE: I X.iih6-Lv)4AM -'I_`.YJ,POM I DATE:
Fee Amt. $158^ Date
Paaii,d: A a
Receipt#: \ O AGy A
Ck#:
Received by:
H S # gC)A\ Q FS
FOR OFFICE USE ONLY
Safety inspection date: ®Pass ®Fail 2nd inspection date:
VDH Food Service
® Floorplan
Reviewd By: _
Date:
0 Approved
OPass ®Fail
I@ Parking O ID
3=
.14
Pox.
PP Ft
3pp
ONE
BEDROOM
STUDIO
APARTMENT
EXTERIOR
LIGHTING
EXTERIOR
LIGHTING
EXTERIOR
LIGHTING
PARKING
� TO MAIN
/DRIVEWAY HOUSE
VEHICULAR
EGRESS
THE COTTAGE
2913 SHIFFLETTS MILL RD. CROZET VA 22932
SITE PLAN (NOT TO SCALE)