HomeMy WebLinkAboutHS202100056 Approval - County 2022-10-12Homestay I
Zoning Clearance Application
Albemarle County
Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
kh0JPW.j96.5S32 i Fax 434.972.4126
Ve cationfee:$173.76
Submit this completed application with the following onijpeortothe add ss b ADWkation$119+Techn rchaRef4.76+1.c tion$sa
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, voterregistratio cCrd,US. passport, others as approved by the Zoning Administrator)
1. Homestay Information J �� I �� //vx{, �O ��
Residentially zoned andruratarea parcels of less th 5 res mayh e2guestbedroomsby-right Useo eca;Srystrudures if built before A August
) is
only permitted by-dghton rural area parcels of 5+acres. Whole house rental Is Only permitted on rural area parcels of 5+acres.
ADDRESS:
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CITY, STATE, ZIP:
2/L 2- v
TAX MAP PARCEL (IF KNOWN):
O
D D - D 0O U 1
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
ACREAGE OF PARCEL:
�.25
NO. OF GUEST BEDROOMS-
USING ACCESSORY STRUCTURES?
❑ YES O
WHOLE HOUSE RENTAL?
WYES ❑ NO
2. Property Owner/Operator Information
NAME:
O a V /
HOME ADDRESS:
35 IlV _ i
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CITY, STATE, ZIP:
+7 2 U
PHONE NUMBER:
—q
— DOI
EMAIL
3. Responsible Agent Information
J YKdo I
elThe responsible agentmustbe available within 30 miles of the homestay atoll times during a homestay use, and must respond and attempt ingood faith to resolve any complaints within 60minutes of being contacted.
P Y W
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EADDRES$:
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EMAIL:
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4.Signature I mal� I -eo jy
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 understa a a i
SIGNAI"VRE:
Fee AMC S369 + 4% Date Pald-
Receipt #:
Ck#:
Received by:
DATE:
FOR OFFICE ,,UeeS'tE�t�ONLY /
Safety inspection datr ✓ ,L V D� l] Pass p FFail 2nd ins .1 Inspection dalr. ttt Pass []Fail
VDH Food Service (if necessary):
Note-: "_---_--
-- APPROVED
Omar ounty
�nmmu..ts„ n_.._, _
❑fioorplan 0 PaarrkiiiJ ID
Reviewd.
d_L��
Approved ❑ Denied
File