HomeMy WebLinkAboutHS202200019 Approval - County 2022-08-16WemnbCountyHomesta Community DeveopmentY(OA
FS I Rd., North Wln tCharlottesville, VA 22902
Zoning Clearance Application Phone 434.296.58321 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following pp)juortothe address above: App +t' illy•r^""°"ns"""""°sa'/e•Imp""0Ay50
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, US. passport, others as approved by the Zoning Administrator)
1. Homestay Information
Residentially zoned and mind arm poi cels of his than 5 acres may how 2guest bedrooms byright Use of accessory structures (if built beforeAugust 7.2019) is
only permitted byriShton rural arm parcels of 5+acres wboh: house rental is only permitted an rural area parcels of 5+acres
ADDRESS:
I 70
CITY, STALE. ZIP:
t(1
TAX MAP PARCEL(IF KNOWN): I, o3160-00-00 —( ZOO
ZONING (IF KNOWN):
1
ADVERTISED NAME Of HOMESTAY OF APPLICABLE): —�'
ACREAGE OF PARCEL'
(P L+
NO. OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
,�...,,//
CI YES Q<O
WHOLE HOUSE RENTAL?
—,
❑YES EINU
Information
NAME
u) S See
HOME ADDRESS:
3
/1
O a C C� •
CITY, STATE. ZIP.
sa Q p
50L�l,
NUMBER:
5 2 & EMAIL: S' eYI LCi u KI LN.I TsGYFIIAT I�
PHONE
r .
3. Responsible Agent Information
The responsible agent mustbeavuilable within 30 milesof thehornestayat all timesdurirtgahomestay use, and must respondard attemptin3oad faith to
resolve any complaints within 60 minutes of being contacted.
NAME:
�es CIL
HOMEADDRESS:
(or
1 t�
STATE. ZIP:
t �l
VI ` rS P'r (O
CITY,
R�✓ EMAIL:[ �/. ��
PHONE NUMBER:
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. I also certify that I have read the
restrictions on homestays, that u erstand them, an I will abide by them.
DArE
SIGNATURE:
Fee Ant: $169 t 4% Date Paid:
Receipt p:
Cit.
Received by
HSg
I OR OFFICE USE ONLY
Safety inspection data []Pass OFall 2ndinspectiandaW ❑Pas: ❑Fall
VDH Food Serwe (if necessary[ 13Flmrplan ❑ Parking I] ID
Notes;
Redewd
Approved Denied
rirci