HomeMy WebLinkAboutHS202200038 Approval - County 2022-12-05APPROVED
by the Albemarle Conti,
�.;�+ v:iy, Atbemarta county
un evelo ment De artmen+
omes �v � P P 9 Community Development
'2 J% 2- Z r 401 McIntire Rd., North Wing
Zoning Cleair�nce �Wieation �� Charlottesville, VA 22902
s"rMass* Ph one 434.296.58321 Fax 434.972.4126
Application fee: E1
Submit this completed application with the followin
g4nllDeortothe address above: rwPlkauo-fsta.rttwnolosr3�rthx�yet4.2e,lmpa,„v$50
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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 ID +one listing the address-acceptableforms
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 2guest bedrooms by -right. Use ofaccessorys ructures lif built before August 7, 2029) is
only permitted Wright on ruralareaparcelsof5+oor s Whale houserentaf is onlypermitted on ruralareaparcels of5+omes.
ADDRESS:
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LPObt`Q,�`E/10
CITY, STATE, ZIP:
/CYYO rS�V�(('�
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TAX MAP PARCEL (IF KNOWN):
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ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE)-
ACREAGE OF PARCEL:
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NO. OF GUEST BEDROOMS'
O
t
w..m
USINGACCESSORY6 RUCTUREA
❑YES ❑NO
WHOLE HOUSE RENTAL?
❑VES ONO
2. Property Owner/Operator Information
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NAME:
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HOMEADDRESS
5qm F•
CITY,STATE. ZIP.
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PHONE NUMBER: _
t
43q ^Z11fra _?4 1z, I
EMAIL:
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3. Responsible Agent Information
The responsible agent most be available within 30 miles of the homestapat all times dmingo homestay use, and must respond and attempt in good faith to
resolveany complaints within 60 minutes of being contacted.
NAME.
HOME ADDRESS:
CtIV. STATE. ZIP.
PHONE NUMBER:
71929
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 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,(hat I witLabide,bv them.
Fee Amt $169 t 4% Date Paid:
Receipt 4:
CkR:
Received by
HSa
FOR OFFICE USE ON)_Y
Safety inspection date: 2 azs ❑ Fail
VDH Food Service lif necessa ):
2M inspection date: _._.__ ❑ Pass ❑ Fail
0Floorplan n Parking [3ID
Reviewd By:
Datc:
proved Denied
IA