HomeMy WebLinkAboutHS202200019 Approval - County 2022-08-18Homestay
Zoning Clearance Application
Submit this completed application with the following online or to the address above:
APPROVED
by the Albemarle County
Community tfvelO frtent Bepertment—
Date
File
- _ - Albemarla County
Community Development
401 McIntire Rd., North Wing
as y` Charlottesville, VA 22902
Phone 434.296.5832 1 Fox 434.972.4126
Application lee: $173.76
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Hoar plan/property sketch with labeled structures used for the homestay, guest bedroonn, owner's bedroom, outdoor lighting
and signage for the hornestay, labeled setbacks, and parking (minimum 2 + 1 spot/guest bedroom).
Copies of two forms of verification of residency (one government issued with photo ID E one listing the address - acceptable forms
include driver's license, voter registration card, U.S. passport, others as approved by the Zoning Administrator)
1. Homeslay Information
Residentially zoned and nenlarm parcehof hm Mon 5 acres my how 28uesl bedrooms by rishL Use at messmy structures (if Will befaeAyeusl 7, 2019) is
onlypemdlled bydaltton rural arm paws of 5e ones. Vdolehous r rentalis onNpnminedonroaloreaparcehof 51 acres
nouerss'
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LAX MAP PARCEI (if KNOWN).
B O— O- OO — I ZOO
ZONING (if KNOWN):
,
ADVERT ISED NAME Of I IOMES1AYRI APPLICABLE). —
ACREAGE Or PARCEL:
I�,
No. or Cut S I PEDROOMs:
USING ACCESSORY STRUCTURES!
❑YES ff2'�
WHOLEHOUSLRI.141W
,t/��'
I]YES li
2. Properly Owner/Operator Information
NAME
S
IIOMEADDRESS:
3 O Q C-t-
CU Y, STATE, 211!
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VQr1 SYI a —1�
NIONFNUMBER'.
e 5 ZR
EMAII:
S er)CW@ k12al6�mu/lc
3. Responsible Agent Information
The responsible agent mustbe ovailable within 30milesof the honlesta,atall tinges doing ahamestayuse, and Must respond andattempt ingood(am to
resolve any rmnplaints within 60minutes, of being concocted.
NAME:
Lkw or Wes C -
I TOME ADORESS:
3 s
CITY. STATE. DP:
VI
PHONE NUMBER:
R� EMAII'
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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 recleved a speclal exception to operate the homestay as a resident manager. I also certify that I have read the
restrictions on homestays, that u)gerstand them, anrt4thyifl will abide by them, 'tin /
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6e le)
M I �FMl @ Wi •, i
Fm Amb$169.4% Dale Paid:
R,egt e:
Receivrtl by:
Ilse
TOR OFFICE USE ONLY
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VDH Food Sewbe la necessary).
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Revinvd By:
Approved Denied