HomeMy WebLinkAboutHS202200037 Application 2022-08-24Homestay
Zoning Clearance Application
Albemarle County
g Community Development
401 McIntire Rd., North Wing
dr. Charlottesville, VA 22902
Phone 434.296.58321 Fax 434.972.4126
Submit this completed application with the followin Application fee: $173.76
gIIDIiROortotheaddressabove: 04pOcarwn$1191T«hmlonS�.IKsa76.$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
Residentially zoned and ruml area parcels of less than 5 acres may have 2 guest bedrooms b y-right Use of occessorystructures (if built before August 7, 2019) is
only permitted by -right on rural area parcels of 5+acres, Whole house rental is only permitted on rural area parcels of 5+arms.
ADDRESS:
.9 2 I
CITY, STATE, ZIP:
C aW� �� t, L.
TAX MAP PARCEL (IF KNOWN):
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABLEI:
ACREAGE OF PARCEL:
NO. OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
❑YES Rl NO
WHOLE HOUSE RENTAL?
❑ YES �NO
2. Property Owner/Operator Information
NAME:
HOME ADDRESS:
Q ip 9A
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CITY, STATE. ZIP:C.
PHONE NUMBER:
()Aj s27L.1
EMAIL:;
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3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestoy at all times during a homestoy use, and must respondand attempt in good faith to
resolve anycomplaints within 60 minutes of beingcontacted.
NAME:
HOME ADDRESS:
CITY, STATE, ZIP:
PHONE NUMBER: EMAIL:
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 1 have read the
restrictions on homestays, that I understand them, and that I will abide by them._
SIGNATURE: _ I DATE:
FOR OFFICE USE ONLY
Fee Amt:$169+4% Date Paid: I 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:
H S # ❑ Approved [] Denied