HomeMy WebLinkAboutHS202100018 Application 2022-06-06 (2)Homestay
Zoning Clearance Application
+� Albemarle County
j yr Community Development
I" < 401 McIntire Rd., North Wing
Charlottesville, VA 22902
,'rr.+•� Phone 434.296.58321 Fax 434.972.4126
Submit this completed application with the following online or to the address above: Application fee: $158
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:
1 3960
CITY, STATE, ZIP: Z- �/
TAX MAP PARCEL (IF KNOWN): 61
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
ZONING (IF KNOWN):
ACREAGE OF PARCEL:
I( J
NO. OF GUEST BEDROOMS:
�-
USING ACCESSORY STRUCTURES?
® YES ® NO
WHOLE HOUSE RENTAL?
® YES ®NO
2. Property Owner/Operator Information
NAME: ell
HOME ADDRESS: �Irl—U
C/J
CITY, STATE, ZIP: .4 .1 r l,.�l f`X.
r-N�'4c O r
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l7 7
PHONE NUMBER:
EMAIL:
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3. Responsible Agent Information
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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.
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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 I understand them, and that I will abide by them.
SIGNATURE: I ' �, 4 _ /f, _ J. I I /L
%- t ,r '"' :! /a" ..1 ��%f !i' ✓f A! rC. DATE
Fee Arm: $158 Date Paid: CJ I }J I ag
Receipt#:
ck#: _GG�I�
Received by:
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FOR OFFICE USE ONLY
Safety inspection date ®pass ®Fail 2nd inspection date:
VDH Food Service (if
Notes:
®Floorplan Ig Parking
Reviewd By.
®Pass ® Fail
® ID
0 Approved 0 Denied