HomeMy WebLinkAboutHS202100015 Approval - Agencies 2021-05-28IfE;, Homestay
Zoning Clearance Application
Albemarle County
r� Community Development
_ - 401 McIntire Rd., North Wing
�•� :•r Charlottesville, VA 22902
Phone 434.296.5832 1 Fax 434.972.4126
Submit this completed application with the following online or to the address above: Application fee: $158
1. Floor plan/property sketch with labeled structures used for the homestay, guest bedrooms, owner's bedroom, outdoor lighting
and signage for the homestay, labeled setbacks, and parking (minimum 2 + 1 spot/guest bedroom).
t/ 2. Copies of two forms of verification of residency (one government issued with photo ID+one listing the address -acceptable forms
include driver's license, voter registration card, U.S. passport, others as approved by the Zoning Administrator)
1. Homestay Information
Residentiallyzoned and rural area parcels of less than 5 acres may have 2 guest bedrooms by -right. Use of accessorystructures (if built before August 7, 2019) is
mlypermitted by-rightonnJuml area parcels of 5+ ones. Whale house rental is only permitted on rural area parcels of 5+acres.
ADDRESS:
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CITY, STATE, ZIP:
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TAX MAP PARCEL (IF KNOWN): 1_: OT�WE)OIybb- d�aDV
ZONING (IF KNOWN):
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ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
L.UIy.IkriouS Cp
&. 1t�Wllfle ACREAGE OF PARCEL:
NO. OFGUEST BEDROOMS:
1,
USING ACCESSORY STRUCTURES?
YES
® NO
WHOLE HOUSE RENTAL?
® YES ® NO
2. Property Owner/Operator Information
NAME:
("Y�. a- y&_
HOMEADDRESS:
Zq 15 9:41L \C S M I I QQd
CITY, STATE, ZIP:
Ctro7-1 2 ZQ 32
PHONE NUMBER:
763. S&i. '312
EMAIL:
��1
Q`�Q�IUf�Q t'•Sn;rley.
3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay at all times during a homestay use, and must respond and attempt in good faith to
resolve any complaints within 60 minutes of being contacted.
NAME:
(A I eKolndlw. �.���yjt %rN
HOMEADDRESS:
Zg l ✓5 t 'CTT�j INA
CITY, STATE. ZIP:
y
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PHONE NUMBER:
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10$ -9 4 - �23121
1 EMAIL:
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 wilt abide by them.
I SIGNATURE: I JeX A6nA*aAA `1 _ t, Y/sf)M I DATE: I I
Fee Amt:$158^.7D.,atee Paid: 1 pk
Receipt#: Vp Q4314
Ck#:
Received by:
HS# C]r%�
FOR OFICEU5�
Safety inspection date: 12� Pass Fail
VDH Food Service (if necessary):
1+i:g1�+- C.L�� P1 c.�
�.ryitI Fitt
Fail
1eJ,r
Date
File
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EXTERIOR
LIGHTING
ONE
BEDROOM
STUDIO
APARTMENT
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)