HomeMy WebLinkAboutHS202200071 Application 2022-12-161_�CA-K 111)5ldsih
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dmestay
Zoning Clearance Application
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Albemarle County
Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
Phone 434.296.58321 Fax 434,972.4126
Application fee: $173.76
Submit this completed application with the following gril;;]g�,ortothe address above: AanliQdon$119+T�Irwlopsumhas,s4Ae+m.pectim$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 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
Residentiall yzoned and rural area parcels of less than 5 acres may have 2guest bedrooms by -right. Use of accessory structures (if built before August 7, 2019) is
onlypermitted by -right on rural area parcels of 5+acres. Whole house rental is onlypermitted on rural area parcels of 5+acres.
TAX
ZONING (IF KNOWN).
/=DVERT'SED
r:i.P. I-QF _IQ MESTAY(IFAPPLICABLE%:
ACREAGE OF PARCEL:
Nn r l GUTs
PESSURY
STRUCTUPES'
❑YES
.-.
WHOLE HOUSE RENTAL?
❑'i ES O
2. Property Owner/Operator Information
NAME:
V k lctr N t OV,G, �55�
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HOMEADDRESS
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CITY, STATE. Zir':
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VA
PHONE NUMBER:
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EMAIL:
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3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay atoll times during a homestay use. and must respond and attempt in good faith to
resolve any complaints within 60 minutes of being contacted.
NAME
I-IOME ADDr.'[
C, 1
CITY. STATE. ZW:
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PHONE N1IL9EER:
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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 I understand them, and that I will abide by them.
SIGNATURE,(�� DATE:
FOR OFFICE USE ONLY
Date Paid Saretyinspectondam: QPass 017all 29dinspecnondzte: ❑Pass []Fail
Receipt #: VDH Food Srwir-i YPner ssmr}� 0 P.3;gica lc7
Ck#: Notes: Reviewd Bic
Rncem-d by: pa;=.
H S # Approved Denied
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CCJ_k7
Payment Receipt
Your transaction has been successfully
completed! I
Your Confirmation number is : 1000545561
Transaction ID: 2211151143737AFFEF57222111511437
11/15/2022 12:46:00 [EST]
Account
Information
Payment Type: Tax Payment
Bill Payer
Detai Is
Marissa Minnerly
6095 Jarmans gap rd
crozet, VA 22932
Payment
Detai Is
Payment Amount: $173.76
Convenience Fee:$4.34N
Total Amount: $178.10
Payment Method: VISA
Card Number:
XXXXXXXXXXXXX7534
Expiration date: 04/2024