HomeMy WebLinkAboutHS202100026 Application 2022-06-06Community Development
homestay u,"'I"
401 McIntire Rd., North Wing
Charlottesville, VA 22902
Zoning Clearance Application 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 - acceptableforms
include driver's license, voter registration card, U.S. passport, others as approved by the Zoning Administrator)
L Homestay Information
Residentiallyzonedand rural area parcelsof less than 5 acres may have 2guest bedrooms by -right Use of aacessorystnx:tures (if built beforeArgust 7, 2019) is
mlypermitted by -right m rural area parcels of 5+acres. Whole house rental is onlypermittedon rural area parcels of 5+acres.
ADDRESS:
11056 Ortrnan Kd
CITY, STATE, ZIP:
on, VA 22920
TAX MAP PARCEL (IF KNOWN):
70- 1 ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
ACREAGE OF PARCEL:
NO. OF GUEST BEDROOMS:Ar
1
USING ACCESSORY STRUCTURES?
Q YES ®NO
WHOLE HOUSE RENTAL?
Q YES ®NO
2. Property Owner/Operator Information
NAME.
ana
OOre
HOME ADDRESS:
1056
rtman Rd
CITY, STATE, ZIP:
Allon,
VA 2 920
PHONE NUMBER:
8 1-
3
EMAIL:
mOOre_OanaQa y OO.COm
3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestayat all times during a homestay use, and must respond and attempt in good faith to
resolve anycomplaints within 60 minutes of being contacted.
ONAME: ld 1Y1VULC
ffEE18341-600-6003
rtman Rd
on> 22 0
E NUMBER: EMAIL: Inloore_oana@V oo.COm
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: fint,, •• ''
WNC � "6�_Jl 1 DATE: 2
Fee Amt $158 Date Paid:
�l*16 11rNumasaMilii
FOR OFFICE USE ONLY
Safety inspection date. QPass 13Fail 2nd inspection date: QPass QFail
Vq Food Service (if necessary): QFloorplan 0 Parking Q ID
Reviewd By:
Date:
❑ Approved Denied
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