HomeMy WebLinkAboutHS202200008 Application 2022-02-21Homestay
Zoning Clearance Application
+ + u Albemarle County
`+ Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
+nea>"r Phone 434.296.58321 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following ,•: I_- or to the address above: Application $u9+Technology Swcha+ge$4.76+hnpecnon$50
1. Floor plan/property sketch with labeled structures used for the homestay, guest bedrooms, owner's bedroom, outdoor lighting
and signage for the homestay, labeled setbacks, and parking (minimum 2 + 1 spot/guest bedroom).
2. Copies of two forms of verification of residency (one government issued with photo ID +one listing the address - acceptable forms
include driver's license, voter registration card, U.S. passport, others as approved by the Zoning Administrator)
1. Homestay Information
Residentially zoned and rural area parcels of less than 5 acres may hove 2guest bedrooms by -right. Use of accessorystructures (if built beforeAugust 7, 2019) is
only permitted by -right on rural area parcels of 5+acres. Whole house rental is onlypermitted on nasal area parcels of 5+acres.
ADDRESS:
l
CITY, STATE, ZIP:
V^A 7,Q
TAX MAP PARCEL (IF KNOWN): 57— `7�
1 ZONING (IF KNOWN):
A
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
`V d� Cp
ACREAGE OF PARCEL:
3t2,q
NO. OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
I OYES 1$NO
WHOLE HOUSE RENTAL?
I IS YES ❑NO
2. Property Owner/Operator information
NAME:
HOME ADDRESS:
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CITY, STATE, ZIP:
Cy-�m PSMIIe von-2--ZgL 3
PHONE NUMBER:
—L L�c \ZJ S^
EMAIL: r
.!'^ r 1Nx,-�
3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay at all times during 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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HOMEADDRESS:
CITY, STATE, ZIP:
I fy 2 Z GA Q 3
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PHONE NUMBER:
s^
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.) also certify that I have read the
restrictions on homestays, that I ur>jilerxtand INA. and that 1 will abide by them.
Fee Amt$169+4 Q(Daate Paid: 91N
Receipt##:: 1l >s
Ck#: ajW
Received by:
HS# ;--r--F'I..M-t.M
FOR OFFICE USE ONLY
Safety inspection date: ❑ Pass ❑ Fail 2nd inspection date:
VDH Food Service (if necessary):
Notes:
❑ Flwrplan ❑ Parking
Reviewd By:
❑ Pass ❑ Fail
❑ ID
Approved ❑ Denied
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