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HomeMy WebLinkAboutHS202200072 Application 2022-12-06Homestay Zoning Clearance Application is Albemarle County Community Development 401 McIntire Rd., North Wing Charlottesville, VA22902 Phone 434.296.5832 1 Fax 434.972.4126 Application fee: $17176 Submit this completed application with the following online or to the address above: Appliotan$tts+Technola svr arge$4.76.Insspwti.$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 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 Residmtiallyzonedand rural area parcels of less than 5 acres mayhove 2ueest bedrooms by -right. Use of accessorystructures (if built before August 7, 2019) is onlypermittedby-righton rumlarea parceisof5+acres Whole houserental isonlYpermittedon mralareaparcelsof 5+acres. ADDRESS: CITY, STATE, ZIP: TAX MAP PARCEL (IF KNOWN): C) o o - vn -oo - 00 ZONING (IF KNOWN): ADVERTISED NAME OF HOMESTAY (IF APPLICABLE): ACREAGE OF PARCEL: 2 � NO. OF GUEST BEDROOMS: USING ACCESSORY STRUCTURES? ❑ YES Iff NO WHOLE HOUSE RENTAL? 1 ❑ YES JO NO 2. Property Owner/Operator Information NAME: P ! HOME ADDRESS: f CITY, STATE, ZIP: zzf 2 PHONE NUMBER: 3 _ _ EMAIL: / 3. Responsible Agent Information The responsible agent must be available within 30 miles of the homestay, at all times duringo homestay use, and must respond ondattempt ingoad faith to resolve anyoomplaints within 60 minutesof beingcontacted. NAME: j S HOME ADDRESS: © !. CITY, STATE, ZIP: r` PHONE NUMBER: �' �! EMAIL:` 4. Signature lvyn 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 1 understand them, and that I will abide by them. SIGNATURE: �/� DATE: //_ �J %. 22 FOR OFFICE USE ONLY Fee Amt: $169 +4% Date Paid: I Safety inspection date ❑Pass ❑Fail 2nd inspection date: ❑Pass El Fail CkA: Received by: VDH Food Service (if necessary): 0 Floorplan Reviewd By. Parking ❑ ID HSn I ❑ Approved ❑ Denied ,x b 11,Y� �- /� G,�t X/ 2�ei� t c �t 7 wlolp/iy olfrH ��k �0012 ulr'.vAou/ 1 --1 i R5y8 S/6W f :14 6 7.