HomeMy WebLinkAboutHS202200026 Action Letter 2022-10-12APPROVED
by the Albemarle County ,,, Albemarle County
Homesta Community Development Depart Mel � Community Development
YDat ib+Z l ' 401 McIntire Rd., North Wing
'ti+� Charlottesville, VA 22902
Zoning Clearan �- a4M;11 r Phone 434.296.58321 Fag434.972.4126
Application fee: $173.76
Submit this completed application with the following online or to the address above: ApVllcatiw$$t9+Techr ioevSurcharge$4.76+InSmUon$5o
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-acceptableforms
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 acres may have 2 guest bedrooms by -right Use of accessory structures (if built before August 7, 2019) is
onlypermitted by -right on ruml area parcels of 5+apes. Whole house rental is onlypermitted on rural area parcelsof 5+0aes.
ADDRESS:
G0o'1 ljJ'4ttW(r V tl,,JtCti F-D.
CITY, STATE. ZIP:
pr r tr E1 22q zo
TAX MAP PARCEL (IF KNOWN):
1 096 00-60-Ob- ot38O
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY(IF APPLICABLEII
ACREAGE OF PARCEL
S. S9q
NO. OF GUEST BEDROOMS
1 -L
USING ACCESSORY STRUCTURES?
[I YES MNO
WHOLE HOUSE RENTAL? I
F(,ES 0NO
2. Property Owner/Operator Information
NAME: MICHAEL L mt-GFle-Lo {�
HOME ADDRESS: 14DO% J({ 6fll Vil" -E� t A
CITY, STATE, ZIP: I Afttrii l 4k v& 1'Lo
PHONE NUMBER: E5 1 t - 3.34 - iZS4 I EMAIL'
3. Responsible Agent Information
,7X (9VtRkl0tA. E..D ld-.
The responsible agent must be available within 30 miles of the homestayat all times duringa homestay use, and must respond and attempt ingood faith to
resolve anycomplaints within 60 minutes of being contacted
NAME:
ft4tC RAEV LlTTLtTli61.D
HOME ADDRESS:
0o-) .5 ^if( %/AAL4,(4
CITY, STATE, ZIP
AFroN r VA Z? t 2,0
PHONE NUMBER:
s'l t - 83y - Tw;l
EMAIL:
tVt(SL'� /� Vta.rrrNM.t�pK
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 exceptiento operate the homestay as a resident manager.) also certify that I have read the
restrictions on homestays, that I undlerA td them, an at 1 will abide by them.
SIGNATURE: I I V >'f ) V"\ I DATE. I
Fee Amt $169 +4% Date Paid: �'�r/ / /_
Receipt k: �, C
Reteiwd/ r: I f,r itSW
HSM-N�%AnA
FOR OFFICE USE ONLY
Safety inspection date: j/ t 0-Z Ly Pass O Fail 2nd inspection date: _ ❑ Pass ❑ Fail
VDH Food Service (if
Notes:
efloorplan ETP/arQk�ing/�/)�/ -WD
Reviewd By:J�
Date:.-9M77 -
IdApproved Denied