HomeMy WebLinkAboutHS202200048 Application 2022-10-10Homestay
Zoning Clearance Application
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Albemarle County
Community Development
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401 McIntire Rd., North Wing
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Charlottesville, VA 22902
Phone 434.296.58321 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following onlineortothe address above: Appllcatlan$119+T«hnobgvsun,haree$4.76+mswtion$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 28uest 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 onlypermitted on rural area parcels of 5+acres.
ADDRESS:
3Z� 5 g& t a
CITY. STATE. ZIP:
�245
TAX MAP PARCEL (IF KNOWN):
O 0 0
ZONING (IF KNOWN):
R
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
ACREAGE OF PARCEL:
NO.OF GUEST BEDROOMS:
(
USING ACCESSORY STRUCTURES?
❑ YES NO
WHOLE HOUSE RENTAL?
❑ YES P 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:
3 0,5 lb 5 _ i3:309 _ —
EMAIL:
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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:
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HOME ADDRESS:
&m&- as Q. Q..
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 I own
the property orthat 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 undeA190 them,,And that I will abide by them.
SIGNATURE: I / 111A17.1f"/// - I DATE: I /A //A. 1:4;4 1
FOR OFFICE USE ONLY
Fee Amt: $169 + 4% Date Paid: Safety inspection date: ❑ Pass ❑ Fail 2nd inspection date:
❑ Pass ❑ Fail
Receipt#:
Ck#:
VDH Food Service (if
Notes:
❑Fioorplan ❑ Parking
Reviewd By:
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