HomeMy WebLinkAboutHS202200037 Approval - Agencies 2022-10-21by the Albemarle County
Community Development Department
Date- /U 2 _7c)Z7,
Homestay File "w,, Albemarle county
2 Community Development
Zoning Clearance 401 McIntire Rd, North Wing
Application p l i eati o n Charlottesville, VA 22902
''^ �` Phone 434.296.58321 Fax 434.972,4126
Submit this completed application with the followingilhu or to the address above: as,,;,,,sll,,Trc6-, Application feeS17_sso ❑
1. Floor plan/property sketch with labeled structures us d f
and slgnage for the homestay, labeled setbacks, and pe or the homestay
arking (minimum 2 a 1 zest bedrooms, bed owner's bedroom. outdoor lighting
2. Copies of two forms of verification of residency lone government Issued with photooto ' bedroom).
the one listing the address -acceptable farms
include driver's fitense, voter registration card, U.S. passport, others as approved by the Zoning Administrator)
1. Homestay Information
Residentially zonedund mml areoparcels of less than S acres mayhoe 2guestbedrppmyy,ryM.1/se of aozuoryshuctura ftf bunt lseloreAugust 7, 20191 n
anlypermittedbyvightonrurala po ,fsM5+ acres WholehouseronkIlsordypenpiMe an �~
parcels of5. dues
I ADDRESS:
/ Tr• --.
4::IkTN2 �mmAyi,4 •I0
,`r'"~,
W�1
CITY. STATE. ZIP,
^ a,
VJ 4
TAX MAP PARCEL OF KNOWN)
ZONING (IF KNOWN':
ADVERTISED NAME OF HOMESTAY (IF APPLICABLEI:
ACREAGE OF PARCEL:
NO_Of GUEST BEDROOMY
ft
USING ACCESSORY STRUCTURES?
❑YES �NO
WHOLE HOUSERENTAL?
I OYES JKNO
2. Property Owner/Operator Information
NAME
I HOME ADDRESS:
.VI•
CITY, STATE, ZIP.
�MntVl
PHONENUMBER1901
EMAIU
3. Responsible Agent Information
li
The responsible agent must be ovaaoble within 30 miles of the homestoyat all tlmesdudngu h0mestoy use, and must respond and attempt in good faith to
resolve any complaints within 60 minutes of being contacted.
NAME:
HOME ADDRESS:
CITY, STATE. ZIP:
I PHONENUMBERi i EMAIL: i
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.
I SIGNATURE: I �_ I DATE: I )k jjA / P A 7 9 I
FOR OFFICE USE ONLY
Fee Amt$169,4% Date Paid: Safety Inspection date: ❑Pass ❑Fad ❑F.,
Receipt a: VDH Food Servke (if necessary). FloorplaI, rWking 1] ID
Cka: Notes: Reviewd BY
Received by Date
HSa pproved ❑Denied