HomeMy WebLinkAboutHS202200056 Application 2022-10-24Homestay
Zoning Clearance Application
Allmmarlo County
Community Development
401 McIntire Rd., North Wing
i k Charlottesville, VA 22902
raxny`r Phone 434.296.5832 1 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following online or to the address above: AVOlatIonsv9+T«I oaSurcharge$a76+InWd;w$So
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
Residentiallirzoned and rural area parcels of less than 5 acres may hove 2guestbedrooms by -right Use of occessorystructures (if buift before August 7, 2019) is
aotypermittadby-ri, dmnualareopa-rdsof5+acres.WlnkbousermtalisO*Per,ndtedmruralareaparcelsof5+acres.
ADDRESS:
I l �0 otfi+ e cSr�.r wQy — -
—
CITY, STATE. ZIP:
�/j�r
Gh Ar1;HeS(4II{. Vj4 ZMd3
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TAX MAP PARCEL (IF KNOWN):
ZONING (IF KNOWN}
Q(S'�ppy
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
p 1 A
ACREAGE OF PARCEL:
O•%?
NO. OF GUEST BEDROOMS:
a
USING ACCESSORY STRUCTURES?
1 ❑ YES IXNO
WHOLE HOUSE RENTAL?
❑ YES ONO
2. Property Owner/Operator Information
NAME_ —
HOME ADDRESS: I1 v0wacf
CITY, STATE,: �7 ✓�-71ha3
PHONE NUMBER: 717- 7S7i-?U#S I
EMAIL: _ _ � e r b r ear jeety lv 0 ja ou
3. Responsible Agent Information
The responsible agent must beavailable within 30 miles of the homestayat all times during a homestay use, and must respond and attem#ingoodfaith to
msohe ony complaints within 60 minutes of being contacted.
NAME:
a(f Shi ,ijT back
HOMEADDRESS:
i Igo &Tm II
CITY, STATE, ZIP:
/,)
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PHONE NUMBER:
C/- s'q2 4130
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 or that 1 have recieved a special exception to operate the homestay as a resident manager. I also certify that 1 have read the
restrictions on homestays, that 1 understand them, d that 1 will abide by them.
SIGNATURE: /f `/ _ _ DATE: lalt-l7_
Fee Amt: $169 ++44% JDatate Paid:1 6 kl /e(p(
Receipt /#:tl/t /�� i/J-w a—_ 1
Ck#:i jd by: W�
Received by:
FOR OFFICE USE ONLY
Safety inspection date: ❑ Pass ❑ Fail 2nd inspection date:
VDH Food Service (if
Notes:
❑ Floorplan 13 Parking
Rev'iewd By:
Date:
❑ Pass ❑ Fail
❑ ID
❑ Approved ❑ Denied
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.c+°r Albemarle County
Short -Term Rental Registry r Community Development
� 1 �' 401 McIntire Rd. North Wing
Charlottesville, VA 22902
Annual Application Phone 434.296.5832
•r'rxriH�' www.albemarlearg
Prior to opening for business, all operators of short-term rentals (including homestays and previously approved bed and breakfasts and
accessory tourist lodging rentals) must:
• Enroll on the Short -Term Rentals Registry with this form
Obtain an approved zoning clearance (requires VDH and building/fire safety inspection)
Register for ab45inesslicenseand remit reauIred tax
Annually following the initial approvals, all operators of short-term rentals must:
• Renew their enrollment on the registry with this form
• Pass afirgsafety insoection
• Renew their bus inesslicenseandrem itreouired taxes
Fields marked with an 'asterisk are the minimum required for registration.
1.Short-Term Rental information
A whole house rental is a short term rental of a home during which the owner is not required to be present. Whole house rentals are only permitted on Rural
Area parcels of 5+acres.
'APPROVED HOMESfAY(HSL BED AND BREAKFAST (BNB), OR ACCESSORY
TOURIST LODGING (ATL) CLEARA14CwElPEER�MIT NUMBER (IF APPLICABLE):
'ADDRESS:
/ BO IA42.. Aj�y, k,
'CITY, SiATE,ZIP:
l0 tovWe V 903
TAX MAP PARCEL KNOWN):
ZONING (IF KNOWN):
R
GUEST BEDROOMS:
WHOLE HOUSE RENTAL:
El YES )I(NO
2. Property Owner/Operator Information
*NAME:
'HOMEADDRESS:
_
•CITY, STATE, ZIP:
✓Gv/�H7� V L Ra 3
PHONE:
'L�r EMAIL:
t�. /A (J GOB
3. Responsible Agent Information
The responsible agent must be available within 30 m Iles 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.
OWNER/OPERATOR IS RESPONSIBLE AGENT:
WES ❑NO IF NO, COMPLETE RESPONSIBLE AGENT INFORMATION BELOW
NAME:
/l'—
HOMEADDRESS:
Q W t
lL/•
CITY, STATE, ZIP:
/v� yr//ter VA ?/�6 2 j'
(!' ✓k
PHONE:
f I .. ,1 2-- 01 �p
EMAIL
(yam
.✓�� n LtG1. 'r 9 rwti; I . cor•.
FOR OFFICE USE ONLLY?Y'7
Fee Amt 0$27 Lo with clearance application
Receipt #:
Date Paid:
Ck #:
Received bta! L
❑ Accepted ❑ Denied
Reviewed by.
Registration Date:
wwmalbemarle.org/homestays v. 9.17.201 Page 1 of 1