HomeMy WebLinkAboutHS202200002 Application 2022-08-25Homestay
Zoning Clearance Application
Submit this completed application with the following online or to the address above:
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Albemarle County
Community Development
401 McIntire Rd, North Wing
Charlottesville, VA 22902
Phone 434.296.58321 Fax434.972.4126
Application fee: $173.76
Application $119-7xhnology Su,charge $4.76, Inspection $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 rural area parcels of less than 5 acres may have 2 guest bedrooms by -right Use of accessary structures (if built before August 7, 2019) is
onlypermitted by -right on ruml area porcels of 5+acres. Whole house rental is onlypermitted on rural area parcels of 5+acres.
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CITY, STATE, ZIP:
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TAX MAP PARCEL (IF KNOWN):
900..00^0Q—d-7yC)d
ZONING (IF KNOWN):
A
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
ACREAGE OF PARCEL:
I D
NO. OF GUEST BEDROOMS:
D-
USING ACCE55ORY STRUCTURES?
YES NO
WHOLE HOUSE RENTAL?
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2. Property Owner/Operator Information
NAME:
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HOME ADDRESS:
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CITY. STATE, ZIP:
PHONE NUMBER:
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EMAIL
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3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay at all times duringa homestay use, and must respond and attempt in good faith to
resolve any complaints within 60 minutes of being contacted.
NAME:
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HOMEADDRESS:
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CITY, STATE, ZIP:
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PHONE NLIMRER: .N.
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EMAIL
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4. Signature
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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 undgQstand them, andsbat I will abide by them.
SIGNATURE: LT _ I DATE: I g •?ZV Z'
Fee Annt: $169 + 4r% I Date Paid:
Receipt N:I�w
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FOR OFFICE USE ONLY
Safety inspecton date: Pass Fail 2nd inspection date: Pass Fail
VDH Food Service (if
Notes:
Floorplan Parking ID
Reviewd By:
Date:
Approved Denied
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