HomeMy WebLinkAboutHS202200063 Application 2022-11-01Homestay
Zoning Clearance Application
AlbemarleCounty
Community Development
it
401 McIntire Rd., North Wing
Charlottesville, VA 22902
Phone 434.296.58321 Fax 434.972.4126
Submit this completed application with the following onlin orto the address above: Arp1fadon$119+TechnaAppication "Surcharge$$4.7e+ll $pe<eoonn$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 ofresidency (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 accessorystructures (if built beforeAugust 7, 2019) is
only Permitted by -right on rural area Parcels of 5+acres. Whole house rental is onlypermitted on rural areo parcels of 5+ocres.
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1� tll�t �A�V�i,
n vl l fUS z Z q(L
l ullXZONING
(IF KNOWN):
PGUEST
(IF KNOWN):
ME OF HOMESTAY(IF APPLICABLE):
J)Z�
OF PARCEL:
nACREAGE
2 ,Q/
EDROOMS:
Z
USING ACCESSORY STRUCTURES?
❑YES NO
WHOLE HOUSE RENTAL?
❑YES NO
2. Property Owner/Operator Information
MGM D2 AVVI
ADDRESS:
P
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TATE,ZIP:
Ii V.4 22 cl f
NUMBER:
6W 8ffI— 827Z
EMAIL:
II 442 L?yffoa1c,
3. Responsible Agent Information
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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 60minutes of being contacted.
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�-il G><✓ADDRESS: 2(f I'GiI
TE, ZIP: (1,,0 QfLG z2�NUMBER: _ EL O' U-I I ' V Z V 1Z'r EMAIL:
dal grPl !�vnn;l.rn'w�
4. bignature
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.
SIGNATURE: I —IIJ4 111,iy 6) a bj/t t& I DATE: I 10 7 (.p/ uZ
Fee Amt$169+4% Date Paid:�� I
Receipt#: IP01p148
Receivedyy b�t D�fq�I!� .Z
HS#CTA" =103
FOR OFFICE USE ONLY
Safety inspection date: []Pass ❑ Fail 2nd inspection date:
VDHFood Servicefrfnecessary): ❑Flomplan ❑Parking
Notes:
Reviewd By:
Date:
❑Pass ❑Fail
❑ ID
Approved n Denied
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CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany this zoning application if the application is not signed by the owner of the property.
I certify that notice of the application for, � �OyF--t m i2Pt K f od
[Name of the application type & if known the assigned application #]
was provided to
[Name(s) of the record owne6 of the
the owner of record of Tax Map and Parcel Number 3141 aNd 31-74 M i I li r- t.o o-e-
by delivering a copy of the application in the manner identified below:
Hand delivery of a copy of the application to
on 101Z-7 12OZZ
Date
Mailing a copy of the application to
Date
to the following address
[Name of a recor owner if a record o er is a
person; if the owner of record is an entity, identify the
recipient of the record and the recipient's title or office
for that entity]
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify the
recipient of the record and the recipient's title or office
for that entity]
[Address; written notice mailed to the owner at the last
known address of the owner as shown on the current
real estate tax assessment books or current real estate
tax assessment records satisfies this requirement].
Signature of Applicant
a171�--o bar. ey
Print Applicant Name
lb/L7/202z
Date
County of Albemarle
Community Development Department
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Page 1 of 1
,s. o""� Albemarle County
• ;?� Community Development
Short -Term Rental Registry QM 401 McIntire Rd. North Wing
Charlottesville, VA 22902
Annual Application Phone 434.296.5832
Ip&.n`" www.albemarle.org
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 zonin(rclearance(requires VDHand building/fire safety inspection)
• Register for a buainess license and remit reouired taxes
Annually following the initial approvals, all operators of short-term rentals must:
• Renew their enrollment on the registry with this form
• Pass a fire safety inspection
• Renew their business license and remit reO it d 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 HOMESTAY(HS), BED AND BREAKFAST (BNB), ORACCESSORY
TOURIST LODGING(ATO CLEARANCE PERMIT NUMBER (IF APPLICABLE): / Cl�
'ADDRESS:,�f. 16 M (
'CITY, STATE, ZIP. A (VI it, IVA Z/A I I
TAX MAP PARCEL (IF KNOWN}: _I ZONING (IF KNOWN):
GUESTBEDROOMS: 2 1WHOLE HOUSE RENTAL: ❑YES
2. Property Owner/Operator Information
*NAME: M a"140 A
'HOMEADDRESS: 31uQ Iulilct
'CITY, STATE, ZIP. /(vV`a� p�� I�-27t7II
PHONE: 5-(O0'v• V - 2 r17 1- EMAIL: aI VVI.may I cLtiljlov�_-,C
3. Responsible Agent Information
The responsible agent must be available within 3Q 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.
OWNER/OPERATOR IS RESPONSIBLE AGENT:
❑YES NO IF NO, COMPLETE RESPONSIBLE AGENT INFORMATION BELOW
NAME:
LT qVI DIIGal"',
HOMEADDRESS:
.2 i V n Mfillt I -VI.
JMA
CITY, STATE. ZIP,
V I DCCSV)- Lt. VA 2 2 rl l l
PHONE:
��[]- �4-I -UZ (Z
EMAIL: _.....—
FOR OFFIE ONLY
Fee Am' 7 13$0 with clearance application
Receipt #: OC"1 iS
Date Paid: /_
Received
❑ Accepted ❑ Denied
Reviewed
Registration Date:_/_/_
www.albemarle.org/homestays V. 9.1T201 Page 1 of 1