HomeMy WebLinkAboutHS202200060 Application 2022-10-27Homestay ornr Albemarle County
�, community Development
=t= � 401 McIntire Rd., North Wing
ZoningClearanceA Application +al>q�1f` Pone434.Charlottesville,6.5A22902
pp Phone 434.296.5832I Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following online or to the address above: Application $119.Teahrology5rcharp$4.76+lrVp ion$50
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 acres may have 2guest bedrooms by -right. Use of accessory structures (if built before August 7, 2019) is
only permitted by -right on rural area parcels of 5+acres. Whole house rental is only permitted on rural area parcels of 5+ocres.
ADDRESS:�GQ
14 V4F
CITY, STATE, ZIP:
g"� ✓ V
TAX MAP PARCEL (IF KNOWN):
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
ACREAGE OF PARCEL:
o% ,
NO. OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
❑ YES 13<0
I WHOLE HOUSE RENTAL?
❑ YES CaIT05
2. Property Owner/Operator Information
NAME:
HOME ADDRESS:
V 4P
CITY, STATE, ZIP:
— KA Z 29j
PHONE NUMBER:
Y3 Z'/
EMAIL:
�
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:
HOME ADDRESS:
CITY, STATE, ZIP:
PHONE NUMBER: 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 I have recieved a special exception to operate the homestay as a resident manager. 1 also certify that I have read the
restrictions on homestays, that I Werstand them, and that Iyyill abide by then. r,
SIGNATURE: I4;ir, ,flea A.Ael W Y 1 i, �. i I DATE' I
Fee Amt:$169+4% Date Paid:'
Receipt #: I am 1
Ck#: _M
Received by: /�t/ _ yy��
H S # ptl125p�(A D
FOR OFFICE USE ONLY
Safety inspection date: ❑ Pass []Fail 2nd inspection date: ❑ Pass ❑ Fail
VDH Food Service (if necessary): ❑ Floorplan ❑ Parking ❑ ID
Reviewd By:
Date:
Approved Denied
Building Sketch
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