HomeMy WebLinkAboutHS202200064 Application 2022-11-01Homestay
Zoning Clearance Application
t�1gy Atbemarte County
Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
Phone 434.296.5832 1 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following onlineortothe address above: Application $119+TecMoiDVSurcharge $4.76+kspection$5o
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 twoforms 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 occessorystructures (if built before August 7, 2019) is
onlypermitted by -right on rural area parcels of 5+acres. Whole house rental is onlypermittedon rural area parcels of 5+acres.
ADDRESS:
CITY, STATE, ZIP:
ie. p
Eo
D
TAX MAP PARCEL (IF KNOWN):
b OOP
50-00-0ZZ 4O
ZONING (IF KNOWN):
R
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
ACREAGE OF PARCEL:
y..,,3.
NO.OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
❑ YES NO
WHOLE HOUSE RENTAL?
ElP YES O
2. Property Owner/Operator Information
NAME:
T e Lee — 41,w Q
HOMEADDRESS:
7�
61) F A RC
CITY, STATE, ZIP:
%
C o f! VA Z 7 o/
PHONE NUMBER:
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EMAIL:/fie
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3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay at all times during o homestay use, and must respond andattempt ingood 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. I also certify that I have read the
restrictions on homestays, that I understand them, and that I will abide by them.
SIGNATURE: N f�A - 1/M n� DATE: ,D �� ..._ C J
Fee Amt: $169 + 4% Date Paid:
Receipt #:
Ck#:
Received by.
HS#
FOR OFFICE USE ONLY
Safety inspection date: ❑ Pass I] Fail 2nd inspection date: 13 Pass []Fail
VDH Food Service (if
Notes:
[] Floorplan ❑ Parking ❑ ID
Revie d By:
Date:
❑ Approved ❑ Denied