HomeMy WebLinkAboutHS202200030 Approval - County 2022-08-25Homestay
Zoning Clearance Application
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Albfit wk CountyCommunity
A
Development
401 McIntire Rd., North wing
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Charlottesville, VA 22902
Phone 434.296.5832 1 Fax 434.972.4126
Appliotion fee: $173.76
Submit this completed application with the following onli or to the address above: App�$119. T.a.olnv Aad.na.$476. u,VK $so
1. Floor pLWproperty 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 lone 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)
L homestay Intwmation
Residvltlah, zoned and nxalarea paroehof less than 5 acres mayhove 2guest bedrooms by -right. Use of acoessorystrucnaes fl(bulR bzforeApust 7.2019) Is
onlypmnitalodby+jgMonnadarea ponds o(S+cross. Whole hotaervsbdisoNypvmittedonrunta pantsof5+crass
ADDRESS:
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CITY.STATE.ZIP.
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C'lw I VA
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TAX MAP PARCEL (IF KNOWM:
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O,56A
ip
O -07.3Z
ZONINGLIFKNOWM:
ADVERTISED NAME OF HOMESTAY(IFAPPUCABLE):
ACREAGE OF PARCEL:
NO.OF GUEST BEDROOMS:
l
I USING ACCESSORY STRUCTURES?
I O a FS Cl NO
I WHOLE HOUSE RENTAL?
❑ vES IR NO
2. Property Owner/Operator Information
NAME:
./DouL(�S "Pig 4c4o,`If 14. IXW
HOMEADDRESS:
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CITY. STATE. ZIP:
C/N'ZE(p�l Va 22 /,3Z
PHONENUMBER.
-'3y-v0Z'0755
EMAIL
LL ^ 11
doe Ld Sc FJH, ldc ovl s"If,%v,(
3. Responsible Agent Information
The responsible agent must be ovoilable within 30 miles of the hwnestay of aR timesdurg a Inrrlestayuae,and must respond ardottanpt InSoodfaifh to
resolve any complaints widen 60minutes of hem contacted.
NAME:
D06(6 Lowf/ -
HOME ADDRESS:
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�,3,,6( r�/(.(j 7-
CITY, STATE. ZIP:
607-fr % UA as c�3a-
PHONE NUMBER:
Y,311-0e2-075S
I EMAIL:
II /
dOsa 6L'Sk pun�L61'l Ssr tin .(
4. Signature
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 relieved a special exception to operate the homestay as a resident manager.) also certify that 1 have read the
restrictions on hoax -Rays, that 1 understand them, and that 1 will abide by them.
SIGNATURE: I /v /. Q. 0� I DATE: I
Fee Amt$169+4% Dade Paid.11ll a�K
Receipt e: IrA,5 3ay
Ck4: I bgs-
Received bv: 040
HSe .s1'.bt:1 -
FOR OFFICE USE ON Y
Sa"w6pechonaate:- oFai
VUH Food Svvim Of neCessary):
Notes
APPROVED
by the Albemarle County
_l cI. �i�:i.,.._
Approved ❑ Denied
44
NI
Date
File