HomeMy WebLinkAboutHS202200041 Application 2022-09-15 (2)rl
Homestay
Zoning Clearance Application
�;t+' ��ra, Albemarle County
>a Community Development
401 McIntire Rd., North Wing
ma's Charlottesville,VA22902
�,�gnayP 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: Appliatm$119.Tmhnaa#rwRwras4.76*1m,,ecfiw$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 2guest bedrooms by -right Use of accessorystructures (if built before Ausust 7, 2019) is
onlypermitted by -right on rural area parcels of 5+acres. Whole house rental is onlypermittedon rural area parcels of 5+acres
ADDRESS:
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CITY, STATE. ZIP:
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TAX MAP PARCEL (IF KNOWN(:
0+300-00-00-00-7160
ZONING (IF KNOWN):
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ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
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ACREAGE OF PARCEL:
V,3
NO. OF GUEST BEDROOMS:
I
USING ACCESSORY STRUCTURES?
YES ❑ NO
I WHOLE HOUSE RENTAL?
❑ YES %Q NO
2. Property Owner/Operator Information
NAME:
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HOME ADDRESS:
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CITY. STATE. ZIP:
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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 of all times duringa homestay use, and must respond and attempt ingood faith to
resolve any complaints within 60 minutes of beingcontocted.
NAME:
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HOME ADDRESS:
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CITY, STATE, ZIP.
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PHONE NUMBER:
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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 I have read the
restrictions on homestays, that I understand them, and that I will abide by them. r
Fee Amt$169+4% Date Paid:
Receipt #: _
Ck#:
Received by:
HS#
FOR OFFICE USE ONLY
Safety inspection date: ❑ Pass ❑ Fail 2nd inspection date: ❑ Pass ❑ Fail
VDH Food Service (if
Notes.
❑ Floorplan ❑ Parking ❑ ID
Reviewd By:
Date:
❑ Approved Denied