HomeMy WebLinkAboutHS202100032 Application 2022-08-11Homestay
Zoning Clearance Application
Y� ===ent
r 401 Mdntire Rd., North Wing
Charlottesville, VA 22902
Phone 434296.58321 Fax 434.972.4126
Submit this cornpleted application with the follovAng Qr j(ne or to the address above: Application fee: $158
L Floor PlaNpropertysketch with labeled structures used for the hom stay, guest bedrOOmS, ovaners bedroom, outdoor lighting
and signage for the homlestay, labeled setbacks, and parking (minimum 2 t1 spot/guest bedroom),
2 Copies of tv" forms Of verification Of residmv.Y late goveirriment issued with photo ID + one listing the address -acceptable form
include driver's license, voterregstrationcard, u-s passport, others as approved by the ZoningAdminlstrator)
i How Information
ADDRESS:
2-3q,j
ti,. F
CrrY. STATE, ZIP.
C
TAX MAP PARCEL(IF KNOWN}
F3a
ZONING(IF KNO4YEs
ADVERTISED NAME OF HOMESTAY (IF APPiJCABW:.
%NOWHOLE
ACREAGE OF PANO.OFGUEST13
DROOMS:
USING ACCESSORY STRUCTURES?
YES ❑
HOUSERENTAL>
2 ProPerty Weer. motion
HOMEADDRESS:MANE
3. Responsible Agent Information
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NAME:.
HOMEADDRESS:
CITY. STATE, ZIP:
LHONENUMBER: I I EMAIL:
4. Signature
I hereby apply for approval to conduct the homestay identified above, and certify drat this address is my lept residence, and that I own
the property ort that I have recieved a special e»eptioo to operate the homestay as a resident manager. I also certify that I have read the
restrictions on homestays, that I un nd them, and wn abi e
SIGNATURE DATE ,
FOR OFFICE USE ONLY
Fee Amt $158 D//at_�, Paid: Safety inspection date ❑ Ross ❑ Fail 2nn ur pectin date ❑ Pass ❑ Fad
Rece7Pt t< 14'3 lG>F) VDH Food Semi (d necessary): ❑ 1`10010- ❑ Paddng ❑ ID
Cku: - 31A� { Notes: —�— Re d By.
Rercived byl.t, Date
HS [jApproved QDenied
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