HomeMy WebLinkAboutHS202200019 Application 2022-04-21"rw AWemarle county
H o m e sta Community Development
Y ) k 401Mdndre Rd., North Wing
Charlottesville, VA 22902
Zoning Clearance Application ac''u.nt r` Phone 434.296.58321 Faa 434.972.4126
Application fee: $173,76
Submit this completed application with the following 01jU or to the address above: Apgratbafssy•Tat+Worys,vsluraef4./6•Iml�tq $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
Residentiallyrorled andwal area porcels of less than 5 acres may how 2suest bedrooms by right Useof accessorystructures fif built beforeAtlgust 7.2019) is
oniyperruilted by-ri9hton rural area parcels of 5+oats. Wholehousesmtal is onNpermittedon rumlareapamelsof 5+acra
ADDRESS:
70 e
CITY
n
//,STATE.ZIP: vl iO
TAX MAP PARCEI. IIF KNOWN): 80-, 0-00'1zoo
ZONING (IF KNOWN):
&PIt4
ADVERTISED NAME Of HOMESTAY IIF APPLICABLE): —�',..,/ACREAGE
OF PARCEL
NO. OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
❑YES ea nu
I WHOLE HOUSE RENTAL?
I OYES
Information
NAME
t0ifflela
HOME ADDRESS:
/l
3 O Q L C,r •
CITY. STATE. ZIP.
aa Qp
toe( SV( ` `a-7
EMAIL: IS? QYICCY @, KI Lµ'VGt7 WalC
PHONE NUMBER:
s J%
3. Responsible Agent Information
The responsible agent mustbeavailable within 30 milesof thehomestayat all timesduring a homestayuse, and must respondarld attemptingood faith to
resolve any complaints within 60 minutes of being contacted.
NAME:fir
A IA1esPen T-
HOME ADDRESS:
(o1ir,
1 t�aj le
STATE. ZIP:
�t ram.
SVIY rS 2a--
CITY,
p
YEMAIL:
PHONE NUMBER:
4.Signature
I hereby apply for approval to conduct the homestay Identified above, and certify that this add ress is my legal residence, and that I own
the property or that I have mcieved a special exception to operate the homestay as a resident manager. I also certify that I have read the
restrictionson homestays, that u erstandthem,an I will abide bythem.
DAfE
SIGNATURE:
Fee Aml: $169 • 4% Date Paid:
Receipt a:
Cka
Received W
HSM
FOR OFFICE USE ONLY
Safety inspection dale f]Pass OFall 2ndinspectiondate: ❑Pass ❑Fail
VOH Food Serace (if necessaryF 0 Floorplan ❑ Parking I] ID
Notes
Reaewd
Approved Denied
a0
H.,
6VI5