HomeMy WebLinkAboutHS202200030 Application 2022-07-11Homestay
Zoning Clearance Application
Athemarte County
ya Community Development
m 401 McIntire Rd., North Wing
Charlottesville, VA 22902
`'rHrixs> 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: Ar katag$119�Ttthnol,,Su,chmre$4.76.Ine ti.nsso
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 2guest bedrooms by -right Use of accessorystructures fif built before August 7, 2019) is
on)ypermitted by -right on rural area parcels of 5+does Whole house rental is onlypermitted on rural arm parcels of 5+ocres.
ADDRESS:
I j36S L.2UZGT f}V,,'�-
CITY,STATE.JP:
II VA 2-Z'?3;-7-
TAX MAP PARCEL (IF KNOWN):
O56A - O'D7,W
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
ACREAGE OF PARCEL:
1,83
NO. OF GUEST BEDROOMS:
1
USING ACCESSORY STRUCTURES?
1 0 tES la NO
I WHOLE HOUSE RENTAL?
I ❑ vFS ;q NO
2. Property Owner/Operator Information
NAME:
A boutt+s toivg 8 Acmaiy M. LxwI —:
HOME ADDRESS:
�3bs C20Zf/ A
CITY, STATE, ZIP:
G/LAUZE% VA 29 93y
PHONENUMBER:
��+
y3v-88Z'o-/JS
EMAIL'
,t 1
3. Responsible Agent Information
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.
M
NAME:
D04(6 z o ivf�.
HOMEADDRESS:
/�3�19- t�dVU( ,#VF
CITY, STATE, ZIP:
Ci rca Lf l VA aa 93a-
PHONENUMBER:
y.3(-l-,ge2-Q7SS
I EMAIL:
�Cxr B`S pur7gCW1SU �7/1n .(
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.) also certify that I have read the
restrictions on homestays, that I understand them, and that 1 will abide by them.
SIGNATURE: , Q• prav� I DATE: _
Fee Amt$169^+4% DatePaid:1I11 sLk
Receipt #: f X5 3aq
Ck#: 1061s-
Receivedl1by:
nr.
H S # a
FOR OFFICE USE ONLY
Safety inspection date: 1] Pass ❑ Fail 2nd inspection date: [] Pass ❑ Fail
VDH Food Service (it necessaryl: ❑ Floorplan
Reviewd By:
Date:
Parking ❑ ID
[] Approved ❑ Denied
41
RECEIVED
COMMUNITY
DEVELOPMENT