HomeMy WebLinkAboutHS202100034 Application 2022-08-11Homestay
Zoning Clearance Application
Submit this completed application with the following online or to the address above:
Albemarle County
a ^'> Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
'�rrrs' Phone 434.296.5832 I Fax 434.972.4126
Application fee: $158
1. Floor plan/property sketch with labeled structures used for the homestay, guest bedrooms, owner's bedroom, outdoor lighting
and signage for the homestay, labeled setbacks, and parking (minimum 2+ 1 spot/guest bedroom).
2. Copies of twoforms of verification of residency (one government issued with photo ID + one listing the address - acceptable forms
include driver's license, voter registration card, U.S. passport, others as approved by the Zoning Administrator)
1. Homestay Information
Residentiollyzonedand ruml area parcels of Tess than 5 acres may have 2uuest bedrooms by -right Use ofaccessory structures (if builtbeforeAugust 7, 2019) is
onlypermitted by -right on rural area parcels of 5+acres. Whole house rental is onlypermitted on rural area parcels of 5+acres.
ADDRESS:
CITY, STATE. ZIP:
ri
TAX MAP PA.RCEL(IF KNOWN):
15�
Ovioo- oo-ao-.—Dono
ZONING (IF KNOWNI:
SFiZ
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
C$
ACREAGE OF PARCEL:
2 .�'
NO. OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
I YES ❑ NO
WHOLE HOUSE RENTAL?
1 ❑ YES
XNO
2. Property Owner/Operator Information
EMIKOKIN«=
i:ffrl
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Q RF
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3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestayatall timesduring a homestay use, and must respond andattempt in good faith to
resolve anycomplaints within 60 minutes of being contacted.
NAME:
HOME ADDRESS:
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 re ' t manager. I also certify that I have read the
restrictions on homestays, that I understand them, and that I wilkabide by them.
SIGNATURE: (N1 9(` l I r (4j% Q\ I IN , i DATE: II^\/ — 7 ln-- 21
Fee Amt: $158/� Date Paid:
M Z,
Receipt #: JV ct
Ck#: ta4tAD
Received by: _ n t,i c lot cin`10. k,
HS# .Z.0210005q
FOR OFF�S�'L1SE ONLY
Safety inspection date: OFF"
�/ ❑ Pass ❑ Fail 2nd inspection date: ❑ Pass []Fail
VDH Food Service (if necessary): ❑ Floorplan ❑ Parking ❑ ID
Notes: Reviewd By:
Date:
❑ Approved Denied
�y OF A(g� Albemarle County
• �_ fir Community Development
Short -Term Rental Registry 403MUesvile, VA 229 Wing
Charlottesville, VA 22902
Annual Application h Phone 434.296.5832
actNSP www.albemarle.org
Prior to opening for business, all operators of short-term rentals (including homestays and previously approved bed and breakfasts and
accessory tourist lodging rentals) must:
• Enroll on the Short -Term Renta Is Registry with this form
• Obtain an approved zoni ng clearance (requires VDH and bu ild ing/fi re safety inspection)
• Register for a business license and remit reouired taxes
Annually following the initial approvals, all operators of short-term rentals must:
• Renew their enrollment on the registry with this form
• Pass a fire safety inspection
• Renew their business license and remit required taxes
Fields marked with an *asterisk arethe minimum required for registration.
1. Short -Term Rental Information
A whole house rental is a short term rental of a home during which the owner is not required to be present. Whole house rentals are only permitted on Rural
Area parcels of 5+ acres.
*APPROVED HOMESTAY(HS), BED AND BREAKFAST (BNB), ORACCESSORY
TOURIST LODGING(ATL) CLEARANCE PERMIT NUMBER(IFAPPLICABLE):
'ADDRESS:
� 51 � n
G
'CITY, STATE, ZIP:
TAX MAP PARCEL (IF KNOWN):
ZONING(IF KNOWN):
s f - I�Rµ !'
J
GUESTBEDROOMS:
WHOLE HOUSE RENT
OYES
2. Property Owner/Operator Information
,'-. •7��
•
IL
3. Responsible Agent Information
The responsible agent must be availablewithin 30 miles of the homestayat all times during a homestay use,and must respond and attempt in good faith to
resolve any complaints within AQ minutes of being contacted.
OWNERIOPERATOR IS RESPONSIBLE AGENT:
9YES ONO IF NO, COMPLETE RESPONSIBLE AGENT INFORMATION BELOW
NAME:
HOMEADDRESS:
S
CRY,STATE,ZIP.
3Z
PHONE:
�rJ
�(]
lr�(„ h
EMAIL:
V-J
FOR OFFICE USE ONLY Date Paid: _/_/_ I ❑Accepted ❑Denied
Fee Amt: 0$27 0$0whh clearance application Ckk:
Registration Date:
L.
www.albemarle.org/homestays v. 9.17.201 Page 1 of I
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__ ___ _-_ _ . _ _ _ ._ Dominion
Igd� 2D21 Customer Bill - � Energye
�SEPH K U H N 4542 DOYLESVILLE RD �.
WHITE HALL, VA 22987
Phtase,t�!ad the
IaStpagl3 foC mpo nt Inf>7t'm8ifgn
atioutb(I(/ng,And
account opt(o�s ava/lab(a
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tiling and Payment Summary
Explanation of Bill Detail
ccount # 5610917600
pue Date Nov°1r; 2021
Customer Service 1-866-DOM-HELP (1-866_366-4357)
Dtal 0lri►py0t
Previous Balance 296.64
Payment Received 300.00CR
avoid a Late Payment Charge
of 1.5% please pay by Nov 26, 2021.
Balance Forward
3.36CR
•evious Amount Due:
$ 296.64
Residential (Schedule 1)
09130-10129
ayments as of Nov 01:
$ 300.000R
Distribution Service
Electricity Supply Svc (ESS)
51.55
Generation
110.91
Transmission
40.59
For service emergencies and power outages please call
Fuel
Non-Bypassable Charges
50.00
-
866=DO4&HELP (1-866-366.4357). Visit us at www.dominionenergy.com.
- -
' -Rider CE Clean Energy -Projects
0.46
eter and Usage
Usage History
Rider R der P PP Un Renewable Universal Seryce Feegm
0.44
0.07
Sales and Use Surcharge
0.54
irrent Billing Days: 29
MooYr
kWh
Nov 20
3820
State/Local Consumption Tax
3.82
illable Usage
Dec 20
3013
ALBEMARLE Utility Tax
4.00
:hedule 1
09130-10129 Jan 21
3475
Total Current Charges
262.38
)tat kWh
2445 Feb 21
4022
assured Usage
Mar 21
Apr 21
4110
3483
Total Account Balance
259.02
eter., 0260623906
09130-10129 May 21
3282
To better understand howyour bill is calculated, visit
2rrent Reading
230846 Jul 21
3669
www.dominionenergy.conuyourbill.
evious Reading
228401 Aug 21
4125
)tat kWh
2445 Sep 21
3786
lrrent Reading
11.65 Oct 21
2801
smand
11.65 Nov 21
2445
ailed on Nov 02, 2021
Manse detach and return this paymeal oaupon with your check madepayable to Dominion Energy Virginia _Plans see reverse side for moiling address change inslrudions.
Payment Coupon
11 Date Nov AV
21 Amount Enclosed
S 2PleaP59.(2 26
Account No. 5610917600
f45,142
2 AV 0.425 T4 0080
SEPH KUHN Send Payment to:
DOYLESVIL RDR02ET VA 32-1932DOMINION ENERGY VIRGINIA
P 0 BOX 26543
RICHMOND VA 23290-0001
888 5610917600 6000026238 8000025902 91
001. 3376721M000I 0021172 0036017 M10000 5610917600 PAGE I OF 4 22022 Z
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