HomeMy WebLinkAboutHS202200029 Application 2022-07-07 (2)Homestay
L
Zoning Clearance Application
Albemarle County
Community Development
401 McIntire Rd., North Wing
is
Charlottesville, VA22902
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 + lnsPcfion $so
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 2uuest bedrooms by -right. Use of accessorystructures (if built before August 7, 2019) is
onlypermitted by -right on rural area parcels of 5+acres. Whole house rental is only permitted on rural area parcels of 5+acres.
ADDRESS:
CITY, STATE, ZIP:
TAX MAP PARCEL (IF KNOWN):
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
ACREAGE OF PARCELt--
NO. OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
❑ YES ❑ NO
WHOLE HOUSE RENTAL?
❑ YES ❑ NO
2. Property Owner/Operator Information
NAME:
HOMEADDRESS:
CITY, STATE, ZIP:
PHONE NUMBER:
EMAIL:
3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay of all times duringo homestay use, and must respond and attempt in good folth to
resolve any complaints within 60 minutes of being contacted.
NAME:
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 I understand them, and that I will abide by them.
SIGNATURE: I DATE:
Fee Amt:$169+4% Date Paid
Receipt #:
Ck#:
Received by:
HS#
FOR OFFICE USE ONLY
Safety inspection date: []Pass ❑ Fail 2nd inspection date: ❑ Pass ❑ Fail
VDH Food Service (if
Notes:
❑Floorplan ❑ Parking ❑ ID
Reviewd By:
Date:
❑ Approved ❑ Denied