HomeMy WebLinkAboutHS202200025 Application 2022-05-18 saoaa 00(:)
a,Semarle County
Homes ay WI ti Community Development
_ J 1W41,, 401 McIntire Rd.,North Wing
•
�• Charlottesville,VA 22902
Zoning Clearance Application l'irctsx'' 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: 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-rightgh on
rural area parcels of 5+acres.Whole house rental is only permitted onrural area parcels of 5+acres.
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ADDRESS. --rvht/vJ/ �,J� � %f/4,17 /� 6'
CITY,STATE,ZIP: J /P A. I/43
TAX MAP PARCEL(IF KNO N) 00 -c ) r 3 — 0 ( AC/'1 l ZONING(IF KNOWN): "QAY `ADVERTISED NAME OF HOMESTAY(IF APPLICABLE): `' ACREAGE OF PARCEL: `5n
NO OF GUEST BEDROOMS: / USING ACCESSORY STRUCTURES', ,'YES El NO WHOLE HOUSE RENTAL? "AYES ❑NO
2.Property Owner/Operator Information //�� /
NAME: • /��.L f J S
HOME ADDRESS: /`22/ "�j vi ��/,✓J
CITY,STATE,ZIP: i6� `tTTO,/ 2,/7/ OY/? P ��T�/V
PHONE NUMBER: ,Zr1, IJGj�J EMAIL: (47 _ " /4 ' 9, !t
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3.Responsible Agent Information LL'' (/ `/ ✓/ t
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 ofbeinga contacted.onta /,�,�/j� /y`/
NAME: /�G'//re 94 D vz'�7 / �!//✓
HOME ADDRESS
CITY,STATE,ZIP. a/I///e /L� V/! N',Q/j�,�/�
PHONE NUMBER: '�/�• �j EMAIL: �/G/�`(///VIJyIJ 417 /4
4.Signature
I hereby apply for approval to conduct the ho••. . ide• ' ed above =nd certify that this address is my legal residence,and that I own
the property or that I have recieved a s r excep •. to operate t•- homestay as a resident manager.I also certify that I have read the
restrictions on homestays,that I un• ta,: hop',and that I wil •bide by them.SIGNATURE: DATE: tel y ��
f
1 FOR OFFICE USE ONLY
Fee Amt:$169+4% Date Paid:51 I ZZ Safety inspection date. ❑Pass 0 Fail 2nd inspection date: ❑Pass ❑Fail
Receipt N: C• • VDH Food Service(if necessary) ❑Floorplan ❑Parking ❑ID
Ck#. C. Notes: Reviewd By:
Received by: Date:
Hsu �22— ❑ Approved Denied