HomeMy WebLinkAboutHS202200059 Application 2022-11-18Homestay
Zoning Clearance Application
of +.ru, Albemarle County
;=� -,j'`'i Community Development
'^ 401 McIntire Rd., North Wing
'' Charlottesville, VA22902
,�+lh.i>r"`� Phone 434.296.5832 1 Fax434.972.4126
Applicationfee: $173.76
Submit this completed application with the following o nljl'ggortothe address above: Application .$119+Technomgysvrcharke$4.v6+msaoction$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 lD+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
Residentiallyzoned and rural area parcels of less than 5 acres may have 2 guest bedrooms by -right. Use of accessorystructures (if built before August 7, 2019) is
onlypermitted by righton rural area parcels of 5+ acres: Whole house rental is onlypermittedon rural area parcels of 5+acres.
ADC)RFSS:
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ZONING {IF KNOWNitaell
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
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OF PARCEL:NC?
OF c�UEST BEDROOMS;
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USING ACCE550RYSTRUGTURES?
❑ YFS �NO
HOUSE RENTAL'
❑ YES
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2. Property Owner/Operator Information
NAME:
HOMEADDRESS:
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CITY. STATE, ZIP.
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PHONF NUMBER:
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3. Responsible Agent Information
The responsible agent must be available within 30 milesof the homestay at all times during o homestay use, and must respond and attempt in good faith to
resolve any complaints within 60 minutes of beingcontacted.
N.AM2
A M L D w WEP-- 1s
HOMEADDRESS�
CITY, STATE, ZIP:
PHONE NUMBER:
EMAIL:
4.Signature
1 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 ex5lapgri to operate the homestay as a resident manager. I also certify that I have read the
restrictions on homestays, that I understalnd epa and that I will abide by them. r
SIGNATURE: PATE: Z( o Z
FOR OFFICE USE ONLY
Fee Amt:$169+4% Date Paid; Safety inspection date: _ ❑Pass ❑Fail 2ndinspectiondate: QPass Oral
Receipt #:
Clot:
Received by:
HSY.
VDH Food Service (if necessary): ❑ Floorplan
Notes:
Reviewd By:
❑ Approved
[] Parking j] ID
Fj Denied
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