HomeMy WebLinkAboutHS202200039 Approval - County 2022-11-18APPROVE_
/a;�.�,m�iie�^.."••. Albemarle County
Homesta ., 'y Community Development
Y InNy Cf vcicpi eni LCh 401 McIntire Rd., North Wing
n�nr • Z >, Charlottesville, VA 22902
� ZoningClearancei�7r"rq�nP Phone 434.296.5832 1 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the followingonline or to the address above: Applla4ion$119+Techntxup surcharge $a.76+Inspa 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 10 + 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 oreo parcels of less than 5 acres may hove 2guest bedrooms by -right. Use of occessorystructures (if built before August 7, 2019) is
ontypermittedby-right on rumlareoporcels of5+aces. Whole houserentol is onlypermitted on rural area parcels of5+acres.
�ADDRESS:
S bPIAA16
CITY,STATE,ZIP:
or
,
TAX MAP PARCEL (IF KNOWN):
TD_
_MO 320
lJ
ZONING (IF KNOWN):
�L
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
I �
kh'
fJ A�
ACREAGE OF PARCEL:
NO. OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
ES
[I NO
WHOLE HOUSE RENTAL?
❑YES G<0
2. Property Owner/Operator Information
(I-- NAME: /71• (ti�o :1�I LL(,
HOME ADDRESS: V 2l
CITY, STATE. Zip: l a. \ A ad- Q®
PHONENUMBER_Q -Okl. 4. `i _._.
EMAIL: m-/_�,
3. Responsible Agent Information W
The responsible agentmust be available within 30 miles of the homestay at all dmesduringo homestay use, and must respondardattempt Ingood faith to
resolve anycomplaints within 60minutes of being contacted.
NAME:
HOME ADDRESS:
01
CITY, STATE. ZIP:
PHONE NUMBER: I FjO, f.rl 3`,*11y -_ 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 fo operate the homestay as a resident manager. I also certify that I have read the
restrictions on homestays, that I u-Wrstand ttyfm, aro(that I will abidebv them.
SIGNATURE:
$173.76
Fee Amt:$169+4% Date Paid: 9/6/22
Receipt #22090616188409911 C166
Ck#: Credit Card
Received by Danielle Summers
HS#
FOR OFFICE USE 0 LY
Safety' inspection date: �1 Vt ❑b/ass ❑Fail 2nd inspection date: ❑Pass ❑Fail
VDH Food Service (if necessary):
Notes:
❑ FloorpWn 1 0 Parking ❑ ID
Reviewd BY:
Approved Denied