HomeMy WebLinkAboutHS202200007 Approval - County 2022-07-07Homestay
Zoning Clearance Application
Albemarle County
Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
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: Applic.b.n $119. T�hrobp S�rdt.,$, $4.76 + Inspection SW
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 + I 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
Residentiollyzonedand rural area parcelsof less than 5 acresmayhove 2guestbedrooms by -right Use of occessorystructures (if built before August 7, 2019) is
onlypermittedby-righton rumlareo parcelsof5+ acres. Wholehouse rental isonlypermittedon rural area parcels of 5+acres.
ADDRESS:
1 571 1
CITY, STATE. ZIP:
I Cl V-1 :r^-
72_z,:3,, C)
TAX MAP PARCEL (IF KNOWN):
1 -7— Pv\ 5- -7 — _55-
ZONING OF KNOWN):
-0
1� rT
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
y ��A_
iv
f�VU,5 �
—
ACREAGE OF PARCEL
3. t3
NO. OF GUE�
TAIL?
I lq YES '140
2. Property Owner/Operator Information
NAME
HOMEADDRESS:
_57724,
1VVAc:,sc-_
CITY, STATE, ZIP:
V L 1, le
7- -3 �-
PHONE NUMBER:
1 EMAIL-
_�110
I
3. Responsible Agent Information
Theresponsible agent mustbeovailable within 30 milesof the homestayatoti timesduringo homestoyuse, and must respond and attempt ingood faith to
resolve any complaints within 60 minutes of being contacted,
NAME
�4 lo 4d ekA Moxr-,,
HOME ADDRESS:
.5_7� �
CITY, STATE, ZIP:
A j Ap
C 164w� /o-17L-c Vt t le VA,
PHONENUMBER:
1 12 1
W 1139 2314 CL4
EMAIL:
4.Signature
I he re by a p ply for approva I to co Ind uct th e h am estay id entifi ed above, a nd certify that th is ad d ress is my lega I resid en ce, and th at I own
the p ro perty or th at I h ave recieved a speci a I exce ptio n to ope rate the h omestay a s a resid ent in a n ager. I a [so certify th at I have rea of the
restrictions on homestays, that 1,yingejIllan0hem, and that I will abide by them. -
Fee Arnt: $169 4 4% Date Paid
jaj,�CL A
Receipt I () T
Ck#: W6
Received by: -PA? ,
FOR OPNCE USE ONLY
Safety inspection date; — [I Pass Cl Fail 2nd inspection date; 0 Pass cl Fail
VDH Food Service (if necessary): 0 Floorplan [3 Parking OID
Reviewd BY:
Date:
E] Approved [] Denied
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