HomeMy WebLinkAboutHS202200007 Application 2022-03-29Homestay
Zoning Clearance Application
Albemarle County
Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
Phone 434.296.58321 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following online or to the address above: Appllcznon$119♦Techn.bpSvrcharge$4.76.lnspecnoa$so
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
Residentiollyzoned 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
only permitted by -right on rural area parcels of 5+acres. Whole house rental is only permitted on rural area parcels of 5+acres.
ADDRESS:
.S / 1 S 1 �r
CITY, STATE, ZIP:
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TAX MAP PARCEL (IF KNOWN):
S — 7 — 55—
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
!V CSE
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FtVUSE I
ACREAGE OF PARCEL:
3
NO. OF GUEST BEDROOMS:
USINGACCESSORY STRUCTURES?
❑YES
�,NO
WHOLE HOUSE RENTAL?
IQ YES VO
2. Property Owner/Operator Information
NAME:,r-
HOMEADDRESS:
CITY, STATE, ZIP:
VL
PHONE NUMBER:
Lis _
_ ys EMAIL:
3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay at all times duringo homestay use, and must respond and attempt in good faith to
resolve any complaints within 60 minutes of being contacted.
NAME:
HOME ADDRESS:
CITY, STATE, ZIP:
Or vt I e VA,
PHONENUMBER:
V2011gcl 23LJr�j
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 lynoe�gtanyhem, and that I will abide by them. _
Fee Amt:$16699+4% Date Paid
Receipt # /COL, t�
Ck#: P W
Received by:
HS#
FOR OFNCE USE ONLY
Safety inspection date: ❑ Pass ❑ Fail 2nd inspection date. ❑ Pass ❑ Fail
VDH Food Service (if necessary): ❑ Floorplan ❑ Parking ❑ ID
Notes: Reviewd By:
Date:
Approved Ej Denied
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