HomeMy WebLinkAboutHS202200017 Approval - County 2022-08-18fa+ s 2022e 00017
�- p• Homestay
Zoning Clearance Application
kAUwnarile
ounty
Develop
Community Development
481 McIntire Rd, North Wing
' Charlottesville, VA22902
Phone434,296.58321 For 434.972.4126
Application fee- $173.76
Submit this completed application with the following online or to the address above: Applkxi $119. Te-N*IM&.dwrp s476. Irepc $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 I D + 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
ResidmtialNZoned and rural arm parcelsof less than 5 acres mar have 2guestbedrooms lift l,Useofaaetsary&vdures fdbuiltbefar August 7,2019) is
onlypermitted by-rightm mml am pacelsof5+at7ea. Whole house rmtal6onNpmmittedm rumlarmparcels of 5+Dues.
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ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESFAY(IF APPLICABLE):
�+-
ACREAGE OF PARCEL:
Q, 23
NO. OF GUFST BEDROOMS:
1
USING ACCESSORY STRUCTURES?
❑YES NO
WHOLE HOUSE RENT,L?
OYES NO
2. Property Owner/Operator Information
NAME:
ld SS e 1 I ahcj Lalkrw (ti t +T 11
HOME ADDRESS:
lY I.� I -R ijl -
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CITY, STATE, ZIP:
C� I,I I
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PHONE NUMBER:
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EMAIL
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3.Responsible Agent Inforation '
The II cp7-c�cy
responsibleogent Intel be available within 30 niilesof the htmestayat all dmetduringo homestay use, andmnt respondandattanpt ing od faith to
resolve anycomplaints within 60mtnutes of heft contacted.
E:HOME
ADDRESS:CITY.STATE,
R
ZIP:
IrICy
QINE
NUMBER
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4. Signature V I U}yXa I I • Llyh
I hereby apply for approval to conduct the homestay identified above, and certify that this address is my legal residence, and that 1 own
the property or that I have redeved "pedalge
exception to operate the homestay as a resident manager. I also certify that I haw read the
restrictions on homestay", than I ur�rstand them, aria tbat I Will abide by them.
Fee Amt E169 ♦ 4% Date Paid:
Recelpt #:
Ck#:
Recelved by:
PAW
FOR OFFICE USE �O/N/LY
Safety inspection date: p7rPaz9 ❑ Fall 2na inspectlon date: ___ ❑ Pas ❑ Fail
VDH Food Service fd necessaryk E3Floorplan P Parking ID
Notes Reviewd By.
ume:
MS/ AVeKOM ❑ Approved ❑ Denied
by the Albemarle County
Community Development Department
Date
File
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