HomeMy WebLinkAboutHS202100040 Approval - County 2021-10-12Homestay
Zoning Clearance Application
Submit this completed application with the following online or to the address above:
,vg y Albemarle County
9p Community Development
8 in 401 McIntire Rd., North Wing
Charlottesville, VA 22902
sr>kcIN1*• Phone 434.296.58321 Fax 434.972.4126
Application fee: $173.76
Applicatwn $119+7mhw1ogy Surcharge $4.76+ Inspection $50
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 listingthe 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 2uuest bedrooms by -right. Use of accessorystructures (if built beforeAugust 7, 2019) is
only permitted by -right on rural area parcels of S+aaes. Whole house rental is onlypermitted on rural area parcels of 5+acres.
ADDRESS:
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CITY, STATE. ZIP:
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TAX MAP PARCEL (IF KNOWN):
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY IIF APPLICABLE):
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cea--1—ACREAGE
OF PARCEL:
NO. OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
I OYES
INO
WHOLE HOUSE RENTAL?
YES ❑NO
2. Property Owner/Operator Information
NAME:
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HOME ADDRESS:
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CITY, STATE, ZIP:
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PHONE NUMBER:
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EMAIL:
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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:
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HOME ADDRESS:
CITY, STATE, ZIP:
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PHONE NUMBER:
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EMAIL
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4.Signature
I hereby apply for approval to conduct the homestay identified above, and certify that this address is my legal residence, and that 1 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.
Fee Amt: $169 +4% Date Paid: % / 1 O1g i
Receipt#: l,) C69
Ck#: 1).9 61
Received by: kg140 2 Iti ✓, V� VI ✓i V
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FOR OFFICE USE ONLY
Safety inspection date: I 0 Pass ❑ Fail
VDH Food Service (if necessary):": 014e�Q
Notes: ��t '��
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APPROVED
by the Albem de County
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Reviewd ��41"
Date: 1n/Py �pl�ent •11
Approved ❑ Denied