HomeMy WebLinkAboutHS202200039 Application 2022-09-07Homestay
Zoning Clearance Application
Albemarle County
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Community Development
401 McIntire Rd., North Wing
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Charlottesville, VA 22902
Phone 434.296.5832 1 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following on�Lortothe address above: Application $119+ Technology Surcharge $4.76+inspeodon$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 rural area parcels of less than 5 acres may have 2 guest bedrooms by -right. Use of accessory structures (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+acres.
ADDRESS:
5 / b ArtA16
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CITY, STATE, ZIP:
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TAX MAP PARCEL (IF KNOWN):
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ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAV(IF APPLICABLE):
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ACREAGE OF PARCEL:
NO. OF GUEST BEDROOMS:
USING ACCESSORY STRUTURES? C
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WHOLE HOUSE RENTAL?
❑ YE5
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2. Property Owner/Operator Information
NAME:
HOME ADDRESS:
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CITY, STATE, ZIP:
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PHONE NUMBER:
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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:
HOME ADDRESS:
CITY, STATE, ZIP:
PHONE NUMBER:
101
Flo. _yj_3 Vi'� EMAIL I JO Z_Lo��,lll^
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 ext,�ption jo operate the homestay as a resident manager. I also certify that I have read the
restrictions on homestays, that I uoj:y stand t n an that 1 will abide.bv them.
SIGNATURE:
$173.76
Fee Amt:$169+4% Date Paid: 9/6/22
Receipt a22090616188409911 C 166
ckft: Credit Card
Received by: Danielle Summers
DATE:
FOR OFFICE USE ONLY
Safety inspection date: ❑ Pass ❑ Fail 2nd inspection date:
VDH Food Service (if
Notes:
❑Floorplan ❑ Parking
Reviewd By:
Date:
❑ Pass ❑ Fail
❑ ID
HSn ❑ Approved M Denied