HomeMy WebLinkAboutHO200400102 Approval - County 2022-08-18APPROVED
by the Albemarle County
Canrnfu n>ty Development Depart, _ t
Date ' "«,_ Mane county
Homestay F.1 Community Development
yle 401 McIntire Rd., North Wing
Zoning Clearance Application Charlottesville, VA 22902
''rAc 1'r Phone 434.296.58321 Fax 434.972.4126
APpIkmtion fer. $173.76
Submit this completed application with the following online or to the address above: Applratbn$119, Tdwk y5,xdwae$4.76,!, t, $So
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
Resitltrdialfyzoned and nralanea Pmedsof kss than 5 acres may have 2guest bedrooms by-rWIL Useafamessary structures if built befortrAygust 7, 2019) is
onlype IN ble-rightonnrdanmirortaba(5+o Molehotsemed kanhpermittedan rurlareaPartxis ofS+acres
ADDRESS:
13LS C/LUZI\i'/
CITY. STATE. DP:
dlj&Zfl y/t
ZZ 932,p
TAX MAP PARCEL OF KNOWN)
D56R -
- V �o731J
ZONINGPFKNOWNY
ADVERTISED NAME OF HOMESTAY OF APPLICABLE):
ACREAGE OF PARCEL:
11.83
NO. OF GUEST BEDROOMS:
t
USING ACCESSORY STRUCTURES?
ONES C11NO
I WHOLE HOUSE RENTAL?
1 01E5 14NO
2. Property Owner/Operator Information
NAME:
told£ �UO/ff M, 1oWs
HOME ADDRESS:
/DdllGL95
I3b - UGUZf f Ay f.
CITY, STATE, ZIP:
6407 f l VA 2-29314-
PHONE NUMBER:
113y-6?S BZ-D/J
EMAIL:
dov, &s bwdA uisN/tin.f
3. Responsible Agent Information
The responsible agent must be avagoble within 30 milesaf the hottestayat all limesdvipoflarltaEay use, and must respond and attempt M good faith to
resa lwanymmplaints within 60 minutes a(bemomilloctild.
NAME:
DO(46 /_0IL)
HOMEADDRESS:
/n-5(- S-- C4V 7-
CITY. STATE. ZIP:
( AV7 f.l VA 97
PHONE NUMBER:
4j_?y-gi92-0755
EMAIL
�Ou @S .bur 0ec"S✓�frn ,(
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 Ihave recieved a special exception to operate the homestay as a resident manager. I also certify that I have read the
restrictions on homestays, that 1 understand them, and that I will abide by them.
I SIGNATURE: 1 12). ). 0• o?v I DATE: I 7-y-.&Z2_
FeeAmt$169.4/�%j DatePad:-1 Jil a4
Receipt a: a;t/1✓ lay
Cka: 1 DPI S"
ReceivedtY:
HSi
FOR OFFICE USE ONLY
safety in6peclion dad. azs O Fay 2nd inspecem dte: 13Pass 13Faa
VDH Food Service Of naessayY. QFborDlan j ,0 ? )D8•'t _
Nolen:
):kre:
0 Approved ❑ Denied
PIA
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