HomeMy WebLinkAboutHS202200036 Application 2022-08-19Homestay
Zoning Clearance Application
¢y Albemarle County
Community Development
m 401 McIntire Rd., North wing
Charlottesville, VA 22902
rrxx�s+ Phone 434.296,58321 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following online or to the address above: Applkatko $119+Tectvalogy5urchar".76+Impiw$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 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
Residentiallyzoned and ruml area parcels of less than 5 acres may have 2guest bedrooms by -right. Use of accessory structures (if built before August 7, 2019) is
only permitted by-dghton mraf areaparcels of 5+acres. Whole house rental is onlypermitted on rural area parcels of 5+acres.
ADDRESS:
G.jpOvl9�
CITY, STATE, ZIP:
TAX MAP PARCEL (IF KNOWN):
+fit Gz-Asl C95`/VV5-1
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
ACREAGE OF PARCEL:
4ry.
NO. OF GUEST BEDROOMS
USING ACCESSORYSTRUCTURE51
I DYES ❑NO I
WHOLE HOUSE RENTAL?
1 ❑YES ❑NO
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2. Property Owner/Operator Information
NAME:
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HOMEADDRESS:
15goo
CITY, STATE, ZIP:
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PHONE NUMBER
43q-Z.0 -?47,I
EMAIL
- L<- '
3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay at all times during a homestay use, and must respond and attempt in good faith to
resolve any complaints within 60 minutes of being contacted.
NAME:
C:�6Lfk.O� W2,5
HOME ADDRESS:
640o
CITY, STATE, ZIP
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PHONE NUMBER:
4sorza -dif 1T.1
EMAIL
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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 recieved a special exception to operate the homestay as a resident manager. I also certify that I have read the
restrictions on homestays, that I understand them, andAhat I wilkabi4egy thgkn.
SIGNATURE: I DATE:
FOR OFFICE USE ONLY
Fee Amt; $169 +4% Date Paid: Safety inspection date: ❑ Pass ❑ Fail 2nd inspection date: ❑ Pass ❑ Fail
Receipt #: VDH Food Service (if necessary): ❑ Floorplan ❑ Parking ❑ ID
Ck#: Notes: Reviewd By:
Received by. Date:
HS#
Approved Denied
J
Fa m i
1254 Old Hillsboro Road
Franklin TN 37069
Bill To
Rebecca West
PO Box 26
Keswick VA 22947
To
Rebecca West
Epona Farm, LLC
5400 Gordonsville Rd
Keswick VA 22947
Sales Invoice
Date I Sale #
7/18/2022 480o84
Ship Date
Payment Method
Memo
Created From
Primary Vet
7/18/2022
Credit Card #
„..««.....
VISA k;7/18 em vet
Coupon Code
Sales Order #SO749180
Can Get USIPS ...
Item
Description
Shipp...
90
Unit Pr...
Total
Order...
Item Actual
Prascend 1mg/tab 160ct
Prascend -160 tab-1 mg/tab
1
0
337.24 337.24
1
025
Thanks! Please check your e-mail confirmation to ensure all information
is accurate.
If your horse or pet's prescription is not already on file with FarmVet, ask
your vet to fax the FarmVet Pharmacy at 615-370-8502. If you have
questions regarding your horse or pet's prescriptions, contact the
FarmVet Pharmacist pharmacist@farmvet.com or 888-837-3626.
Federal Law prohibits the return of prescription medications. Please
Subtotal 337.24
Shipping Cost (FedEx Residential Ground) 0.00
Total $33724