HomeMy WebLinkAboutHS202100042 Application 2022-06-06Homestay
Zoning Clearance Application
+r'°b Albemarle County
JI +Z Community Development
/01 McIntire Rd., North Wing
rti` Charlottesville, VA 22902
Phone 434,296.58321 Fax 434.972.4126
Submit this completed application with the following mUM or to the address above: Application fee: $158
1. Floor plan/property sketch with labeled structures used for the homestay, guest bedrooms, owner's bedroom, outdoor lighting
and signage for the homestay, labeled setbacks, and parking (minimum 2 + 1 spot/guest bedroom).
2. Copies of two forms of verification of residency (one government issued with photo I D + one listing the address• acceptable forms
Include driver's license, voter registration card, U.S. passport, others as approved by the Zoning Administrator)
1. Homestay Information
Resdmtkltp emedand rural area parcels of less than 5 acres may have 2guest bedrooms by -right Useo(accessorystnxYures (i(builtbelgeAiroW ), 2019) Is
onypermitted by- hton rural arm parcels of5+annes. Whole house sentulisoniypermittedon ruralareaparcds of5+ones
ADDRESS:
CITY, STATE. ZIP.
TAX MAP PARCEL (IF KNOWN):
ZONING IIF KNOWNk
ADVERTISED NAME OF HOMESTAY IIf gPPLKABLEI;
ACREAGE OF PgRCEL:
NO. OF GUEST BEDROOMS USING ACCESSORY STRUCTURES. ❑YE$ ❑NO WHOLE HOUSE RENTAL. AYES
a � ❑ NO
2. Property Owner/Operator Information
NAME:
HOME ADDRESS: 2
CITY STATE. Zip:
PHONE NUMBER: r n 1 r
l`�_ 1"..tl'�J_ -.L 1._\_L._. EMAIL
3. Responsible Agent Information
The—poruibleogent must be ovollable within 30mites of the hi,nkstayotolltimesdudngahonx tayuse, andmust respoMwdottemptinyood(alth to
resolveamwmploints MENA 60mirrutecof bdna.xXNd
TAME: _.
HOMEADDRESS:
CITY, STATE, ZIP
PHONE NUMBER: 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 derstand them, aM that l will 01de
.by1them.
SIGNATURE: M'1A DATE .__.
FOR OFFICE USE ONLY
Fee Amt Sl Sa Wit -Paid:
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Notes:
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Receivedby
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Dale:
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❑ Approved
n Denied
WON
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