HomeMy WebLinkAboutHS202200045 Application 2022-10-04Homestay
Zoning Clearance Application
,rt Albemarle County
ic` -rP Community Development
401 McIntire Rd., North Wing
i Charlottesville, VA 22902
Phone 434.296.58321 Fax 434.912.4126
Application fee: $173.76
Submit this completed application with the following online or to the address above: Application$119+Technology Surcharge $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
Residentially zoned and rural area parcels of less than 5 aaes may have 2guest bedrooms by -right. Use of accessorystructures (if built before August 7, 2019) is
only aamitted by -right on rural area parcels of 5+acres. Whole house rental is onlypermitted on rural area parcels of 5+aaes.
ADDRESS:
CITY, STATE, ZIP:
TAX MAP PARCEL (IF KNOWN):
to ADC), 00 %) QO
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
1 1 ii— (�, Oki-
ACREAGE OF PARCEL:
(3� •_I
NO. OF GUEST BEDROOMS:
3
.USING ACCESSORY STRUCTURES?
❑ YES NO
WHOLE HOUSE RENTAL?
®"YES ❑ NO
nwnpr/nnpratnr Information
NAME:
C-
HOMEADDRESS:
CITY, STATE, ZIP:
q�S "Z'
PHONE NUMBER:
- 1� — EMAIL:
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.
I r cocyY
NAME:
,
HOME ADDRESS:
CITY, STATE, ZIP:
2Q
PHONE NUMBER:
vl W
EMAIL:
(� cc-s ,
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 1 have recieved a special ception to ra a homestay as a resident manager. I also certify that I have read the
restrictions on homestays, that I undSpilefid them, an at I will a ide by them.
SIGNATURE: DATE:
Fee Amt$169+4% Date Paid:
Receipt #:
Ck#:
Received bby/:�/� j�/�j
H S #2I��y.1.1 —0004
FOR OFFICE USE ONLY
Safety inspection date [3Pass ❑ Fail 2nd inspection date: 13 Pass ElFail
VDH Food Service (if
Notes:
❑Floorplan ❑ Parking ❑ ID
Reviewd By:
Date:
❑ Approved ❑ Denied