HomeMy WebLinkAboutHS202200015 Application 2022-04-01 H o m estay .:0 "�`u, Albemarle County
�i►, Community Development
�. ®iY; 401 McIntire Rd.,North Wing
Zoning Clearance Application ,. ., ,'` Charlottesville,VA 22902
Tin ``,- Phone 434.296.5832 1 Fax 434.972.4126
Application fee:$173.76
Submit this completed application with the following opjirle or to the address above: Application$119+Technology 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 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
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: 3 L, ..:.ti S--T,DYv l�fi IRC e r\Q —
CITY,STATE,ZIP: r It _j I ]—A—e i(l le- \IA-- ��� '
TAX MAP PARCEL(IF KNOWN)' l ZONINGj(IF KNOWN).
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE): ACREAGE OF PARCEL:
NO.OF GUEST BEDROOMS: / J USING ACCESSORY ST TURES? L❑YES 0 NO I WHOLE HOUSE RENTAL? li YES ❑NO
2.Property Owner/Operator Information
NAME --
t"Ieimeti d" 11 I �Viv\V I.Al2e lc
I COME ADDRESS: t�/Z �� O 3 � � L I
CITY,STATE,ZIP: (. �k 1h+- ,\r+ 1 (c, L1 /�/� L_ 1 ) I
PHONE NUMBER: T-c I 7 1! >/ T j `
-7/ ti EMAIL: AL I C I A-V („_`(l)nt s,A '
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►`f
HOME ADDRESS _3lr _! 'IN. ��t c* Tc)C-�
CITY.STATE,ZIP: -A r k-�es vI( Ie VA ,2.a 1 t ,J
PHONE NUMBER: 0...R..l // )/ EMAIL. AL:1C-; 4 V ' i )i- S1�, L�,L_
ll `i 1 t —l�7/
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 and stand them,and,tha I will abide by them.
SIGNATURE: F���fA_ w / — I DATE l / —
FOR OFFICE USE ONLY
Fee Amt:$169+4% Date Paid Safety inspection date. 0 Pass 0 Fail 2nd inspection date: ❑Pass ['Fail
Receipt#: VDH Food Service(if necessary):__!-- 0 Floorplan 0 P rking 0 ID
Ck#: —!� Notes: Reviewd By'
Received by: Date: _
H S# X Y '3(')OC\ ❑ Approved 0 Denied
.0111 __
-c _ �UM= r=m �� --
Driveway and parking
3 stairs from drive
and to house
Refrigerator
Kitchen & / Kitchen sink
Bedroom area /�
Dining area Window
Living Area
Window
_ Dishwasher
1 1
1 1
M U '" Washer/Dryer
,.,. Sliding glass doors Roo
Shower Toilet Bathroom
Window
sink