HomeMy WebLinkAboutHS202200044 Application 2022-10-03Homestay
Zoning Clearance Application
Albemarle County
Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
rrgav Phone 434.296.58321 Fax 434.972.4126
Appkatlon fec SIM6
Submit this completed application withthefollowing onh artothe address above: AppOuthinS219,TedwaIMSMEtSA76.o-aPIII�xrsw
1. Floor plan/property sketch with labeled structures used for the homestay, guest bedrooms, owners bedroom, outdoor lighting
and signage for the homestay, labeled setbacks, and parking (minimum 2 + 1 spotilgaest bedroom).
2. Copes 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
ReddentialN zoned and rural ores porc& of im than 5 ones may have 2guest bedrooms by -right Use of accessory structures (it built before August 7, 2019) is
anN permitted by -right on rural oreo parcels of 5+acres. Whole house rental is ordypermitted on rural area parcels of 5+ocres.
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CITY, STATE. ZIP:
Cr; ✓fle-
ZONING (IF KNOWN):
TAX MAP PARCEL (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
ACREAGE OF PARCEL:
I -2
NO, GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
❑ YES ❑ NO
WHOLE HOUSE RENTAL?
11 YES ❑ NO
r..r ....e./n..er-+erinfnr--H—
NAME:
L ( iJ )i'11y/. -�' vZ
HOME ADDRESS:
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CITY, STATE. ZIP'
a
p
Vy q L,2- Iftv L
PHONE NUMBER:
fJ. - 62 / )?6
I EMAIL:
hM1(v y) --1 / J '
3. Responsible Agent Information
The responsible agrra must be availablewifhan 30 miles of the tnnlestayat all times dudnga hwmrstayuse, and trust respordand attempt ingoodfalth to
,wive anycomplaints within 60 minutes of beins contacted.
NAME:
HOME ADDRESS:
CRY, STATE, ZIP:
PHLNJE NUMBER' I 1 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.) also certify that I have read the
restrictions on homestays, that I understand them, and that I will abide by them.
SIGNATURE:
Fee Amb 3169E 4% Date
Received by.
HSa
FOR OFFICE USE ONLY
Safety inwKtfon date: QP-s O Fait 211t inspection date: l3Pass O Fail
VDH Food Service (if
NWes
E3 Floorplan ❑ Parking ❑ID
Revicwd By:
❑ Approved ❑ [Denied