HomeMy WebLinkAboutHS202200031 Application 2022-07-18Homestay
Zoning Clearance Application
Submit this completed application with the following online or to the address above:
n"4 Albemarle County
a �? Community Development
=)= R 401 McIntire Rd., North Wing
Charlottesville, VA 22902
,'rrmlatar Phone 434.296.5832 1 Fax 434.972.4126
Application fee: $173.76
Application $119+ Tedurobgy Surcharge $4.76. Impectlon $50
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
Residentiallyzoned and rural area parcels of less than 5 acres may have 2guest bedrooms by -right. Use of accessorystructures (if built beforeAugust Z, 2019) is
only permitted by -right on rural area parcels of 5+acres. Whole house rental is only permitted on rural area parcels of 5+acres.
ADDRESS:
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CITY, STATE, ZIP:
G Na a. 9 l
TAX MAP PARCEL (IF KNOWN):
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
ACREAGE OF PARCEL:
a
NO. OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
❑YES NO
WHOLE HOUSE RENTAL?
❑ YES NO
2. Property Owner/Operator Information
NAME:
HOME ADDRESS:
CITY, STATE, ZIP:
N
PHONE NUMBER:
b— _
EMAIL
RGd G
3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay at all times duringa homestayuse, and must respond and attempt in good faith to
resolve arrycomplaints within 60 minutes of being contacted.
NAME:
4�90 c
HOME ADDRESS:
CITY, STATE, ZIP:
G
PHONE NUMBER:
i C? —
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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 orthat I have recieved a special exception to operate the homestay as a resident manager. 1 also certify that 1 have read the
restrictions on homestays, that I understand them, and that I will abide by them.
I SIGNATURE. I w- _ _ . �20V I DATE: I n -- / L/—'1 'l I
Fee Amt$1699+4% Date Paid. Ll QQ
Receipt#: -70
Ck#: r�1 1Q
Received by: L) M s
HS# "A- 31
FOR OFFICE USE ONLY
Safety inspection date: ❑Pass []Fail 2nd inspection date: ❑Pass ❑Fail
VDH Food Service (if necessary): ❑Floorplan [3 Parking ❑ ID
Notes:
Reviewd
Approved i1 Denied
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