HomeMy WebLinkAboutHS202200050 Application 2022-10-10Homestay
Zoning Clearance Application
Submit this completed application with the following online or to the address above:
Albemarle County
Community Development
]- 401 McIntire Rd., North Wing
Charlottesville, VA 22902
Phone 434.296.58321 Fax 434.972.4126
Application fee: $158
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 accessory structures (if built beforeAugust 7, 2019) is
onlypamitted by -right on rural area parcels of 5+acres. Whole house rental is onlypermitted on rural area parcels of 5+0cres.
ADDRESS: 2507 Cedar Ridge Ln
CITY, STATE, ZIP: harlottesville, VA, 22901
TAX MAP PARCEL (IF KNOWN): ZONING(IF KNOWN): RA
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE): ACREAGE OF PARCEL: 2.01
NO. OF GUEST BEDROOMS: 1 USING ACCESSORY STRUCTURES? FED YES ❑ NO WHOLE HOUSE RENTAL? 1 ❑ YES ONO
2. Property Owner/Operator Information
NAME: NicolaasJackie van der Westhuizen
HOME ADDRESS: 2505 Cedar Ridge Ln
CITY, STATE, ZIP: Charlottesville, VA, 22901 -
PHONE NUMBER: 4349870112 EMAa: Jackie.van.der.westhuizen07@grri
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 Jackie van der Westhuizen
HOME ADDRESS: 2505 Cedar Ridge Ln
CITY, STATE, ZIP: Charlottesville, VA, 22901
PHONE NUMBER: 4349870112 EMAIL: ackie.van.der.westhuizen07@gmaA
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.
SIGNATURE: Nicolaas Jackie van der Westhuizen ogba'ry•'emdbyHsaaaaw.ckbvan dr1Wrsba—n DATE: /25/2021
Dale :2021G.251113:23-
Fee Amt. $158 Date Paid:
Receipt #:
Received
/^by:
HS#
FOR OFFICE USE ONLY
Safety inspection date: ❑ Pass ❑ Fail Zinc inspection date:
VDH Food Service (if
Notes:
13 Floorplan Parking
Reviewd By:
Date:
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❑ ID
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