HomeMy WebLinkAboutHS202200069 Approval - County 2022-12-02APPROVED
by theAlbemarle County
HOmeStaommlm De I V Department
Zoning Clearance Application
Submit this completed application with the following online or to the address above:
�,+^4 Albemarle County
- . red Community Development
)- 401 McIntire Rd., North Wing
T Charlottesville, VA22902
,� ;1 vy Phone 434,296.58321 Fax 434.972.4126
Application fee: $173.76
App1✓atl.$119 r Ted l sy Surcl,uga$4.76+ ImpKd"$Sa
1. Floor Plan/property sketch with labeled structures used for the homestay, guest bedrooms, owner's bedroom, outdoor fighting
and slgnage 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 2ueest bedrooms by -right. Use of accessorystructures (if builtbefore August 7. 2019) is
only permitted by -right on mml area parcels of S+acres Whole house rental is onlypermitted on rural area parcels of 5+ocres.
ADDRESS:
ZZ15, ROC.—1.404,fJpr"\-
ced-k I\- 'Z.2-c1 �rq
CITY. STATE. ZIP:
IJo v pr
`t.,7-1 ,
TAX MAP PARCEL (IF KNCAV4
f(}OO — OO —0, ,40
ZONING (IF KNOWNY
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
t R ^/ i
ACREAGE OF PARCEL:
2.O
NO. OF GUEST BEDROOMS: `.'
�j
USING ACCE55ORY STRUCTURES?
DYES
NO
WHOLE HOUSE RENTAL?
❑YES NO
2. Property Owner/Operator Information
NAME:
HOME ADDRESS:
CITY, STATE. ZIP:
r) p l Nr� u-�� (�- Z z_q f 9
PHONE NUMBER: ..
Z1�y Zftt '2iZ0�
EMAIL: -
A'�alt�- annyorJo'��u ntw
3. Responsible Agent Information
The responsible dgemmust be available within 30 miles of the homestayat all times during o homestay use, and mustrespond and attempt in good faith to
resolve any complaints within 60 minutes of beingcontacted.
NAME;
HOME ADDRESS:
(01Z Ce.,% ),t' /J
CITY, STATE. ZIP:
yV iC.tL r✓A, �iyrry T
PHONE NUMBER:
GOi�([lif lyy
EMAIL:
TJ RQR(05�rw •O�C'
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 W ndegtand therm and that)-vVFV'aI jde by them.
SIGNATURE.
Fee Amt$169+496 Date Paid:
Receipt N -
Cka:
Received by.
HS4
FOR OFFICE USE
. ONLY
Safety inspection date. F., ✓�I'✓ ass
VDH Food Service (if necessary)'
Notes
DATE: i l O h Eo
❑ Fail 2nd inspection date: ❑Pass ❑Fail
❑Fimplan Pai-ki ❑ID
ReWewd BY '...
Date L2— -� --
0- proved Denied