HomeMy WebLinkAboutHS202100043 Approval - County 2021-09-30Homestay
Zoning Clearance Application
40MmarCounty
y Community Development
- 401 McIntire
Rd., North Wing
Charlottesville, VA 22902
�.,•'r Phone 434.296.58321 Fax 434.9T2.4126
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).
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
Residentially zoned and rural area parcels of less than 5 acres may have 2 guest bedrooms by -right Use of accessory structures (if built before August 7, 2019) is
onlypermitted by -right on rural area parcels of 5+ acres. Whole house rental is only permitted on rural area parcels of 5+acres.
ADDRESS:
I 2y
Gr �L
CITY. STATE. ZIP:I
al
l
D
TAX MAP PARCEL (IF KNOWN):
oboo-0-
J�
0 ry D1 — D— 02 Q
ll
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
ACREAGE OF PARCEL:
NO. OF GUEST BEDROOMS:?...
1 USINGACCESSORY5TRUCTURES?
❑YES NO
I WHOLE HOUSE RENTAL?
I ❑YES NO
2. Property Owner/Operator Information
NAME:
/I
HOME ADDRESS:
.C..
CITY. STATE, ZIP:
2 1 C
PHONE NUMBER:
04 — —E,-�/Of
EMAIL:
1J iris
3. Responsible Agent Information
The responsible agent must be ovafrable 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.
Im
NAME:
HOMEADDRESS:
CITY. STATE, ZIP:
G/
PHONE NUMBER:
OL -'2 — 0
EMAIL:
/y7
4. Signature
1 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 yaderstagd themes I will abide by them. A _ ,
I SIGNATURE: I k I— \1 I DATE I -I I I W // L//J I
Fee Amt$158 Date
Receipt 8:
Ckg:
Received by: /n
H S N
FOR OFFICE USE ONLY by the Albemede County
////rrrr ^�S COnfRection dt De ve prllerl�r
Safety inspection date: A'�p__ QPa55ai1 ��6pection date: 1 Pass ❑Fail
VDH Food Service (if necessary): TPonDtplan Par l in
Notes: sUM4 kl t .A(n— Reviewd By:
Date:
—s�ar�a�-nb Approved F1 Denied
0
Q�kj(, v I� _GaUaS
`'°-- ``0
L4 �\
qL
r+�S
9vx
cNq Jerk
_ VAS —
pceH'\Wu�j
tig