HomeMy WebLinkAboutHS202200046 Application 2022-10-10Homestay
Zoning Clearance Application
u ^'n Albemarle County
>p Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
4'Ana�t*v♦ Phone 434.296.5832 1 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with thefollowinggnibleortothe address above: AoWr.twn$nv*Tea.worrs.r0.V$4.76,1mwti.S5o
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 I D + one listing the address - acceptable forms
include driver's license, voter registration card, U.S. passport, others as approved by the Zoning Administrator)
I. Homestay Information
Residentially zoned and rural area parcels of less than 5 acres nay have 2glest bedrooms by -right. Use of accessory structures (d built before August 7, 2019) is
onlypermitted by -right on rural area parcels of 5+acres. Whole house rental is only permitted on rural area parcels of 5+acres.
ADDRESS:
510 6YeA to v vr )L
CITY. STATE. ZIP:
q
Grrr.rNi1I VIL4,+,w, VA 2-Z-'IQ3
TAX MAP PARCEL (IF KNOWNI:
0-f 300 - 00 — 00 - 034,F I
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
I 5YDgA^OF-r, &J0TAWA.
ACREAGEOF PARCEL:
I 5.35
NO.OF GUEST BEDROOMS:
(
USING ACCESSORY STRUCTURES?
❑YES ONOWHOLE
HOUSE RENTAL?
I OYES MrNO
2. Property Owner/Operator Information
NAME:
cw 5M1'M
HOME ADDRESS:
30I0 51{CAMOfa40- ¢JVo(IM 112-A1L-
CITY. STATE, ZIP:
�il'1'J>,: i:-1�OT-Il.�s V I t.Lt� r VA '2-2.q 0 3
PHONE NUMBER:
y?jz-{. Z.QJZ. (/(OQ a'
EMAIL:
J2r7d rsv'i;+if Mat�•Go
3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay stall times dudnga homestayuse, and mtstreyardandattempt in good faith to
resolve anycomploints within 60 mirmtesof beingcontacted.
NAME:
SAMl5- AS 47I2-0P9:FL-r ( OvveJE p )
HOME ADDRESS:
CITY. STATE. ZIP:
PHONE NUMBER:
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 1 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 thatjAQ11 abide by( them.
SIGNATURE: DATE: / 490�
FOR OFFICE USE ONLY
Fee Amt: $169 + 4% Date Paid: Safety inspection date. 13Pass 0 Fail 2nd inspection date: ❑ Pass 0 Fal
Receipt 4: VDH Food Service (if necessaryk t] Floorplan ❑ Parking ❑ ID
Ckx: Notes: Reviewd By,
Rccchv d by: Datc:
HStt 0 Approved ❑ Denied
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STALE:
SHEET:
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