HomeMy WebLinkAboutHS202200051 Approval - County 2023-01-05,. �R. Albemarle County
APPROVED � y Community Development
Z\ Homestay by the Abemarle County 401 McIntire Rd., North Wing
-` Charlottesville, VA 22902
✓ i . rrn eat 0e artme r a t�r Phone 434.296.58321 Fax 434.972,4126
Zoning Clearance tad Pb
Application fee: $173.76
Submit this completed application with the following.QWbu or to the address above aodow„sus. rKmoaers Mors-snxrc S-
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, US. passport, others as approved by the Zoning Administrator)
L Homestay Information
Residentialtyzoned and rural area par Ws of less than 5 acres may haw 2guest bedrooms fry -right Use of accessory structures (if built before August 7, 2019) is
only Permitted by -right on ruroiarea parcels of 5+acres. N7wk house rental is only permitted an rural area parcels of 5+acres_
ADDRESS:
aI(oS I'I�1OW'�-IQ-I r,\ Wa
H
CV,S TATE, ZIP:
CkLtytC++e-SvllIQ VA Aaqll
TAX MAN PARCEL (IF- KNOWNI:
ZONING (IF KNOWN%
ADVERTISED NAME Or HOMES LAY (IF APPLICABLEI:
ACREAGE OF PARCEL:
tACJZE
NO. OF GUEST BEDROOMS:
I
USING ACCESSORY STRUCTURES?
❑YES XNO
WHOLE HOUSE REENAL?
❑YES %NO
2 Property Owner/Operator Information
NAME:
THOMA!S SWING _
HOME ADDRESS:
aI(o5 m Abowr—iEL.D wA`
CITY, STATE. ZIP.
CH4VP-W-r-'rES\(ILLE t `/_A aa4 t\
PHONE NUMBER
-149,(p—La35 of
I EMAIL
-THUMa<+S. A. EI.JiNLy �<,MAILI
3. Responsible Agent Information
The responsible agentmust be av;idoble within 30 miles of the homestay at ail times duringa tnmestayuse, and must respond and attempt ingood faith to
resolve any complaints within 60 minutes of being contacted.
NAME: I-TiiDMAS Owlbj6
HOME ADDRESS: atlas MEAIIOWFIE(,D WW
Cm. STATE, ZIP: CPAP—tAT-(-ESvILL-E, VP, aQi�\11
PHONE NUMBER: I2�"t a-4a6-t ASS-'Cl IEMAIL-rH0PAAS.A-EWIMC-1Q(sMA\L-
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 1 understand them, and that I will abide by them.
SIGNATURE: _.. _��../l.Viq DATE:
Fee Amt $169 ., 4% Date Paid:
Receipt a- _-
ReceMed
HSR
FOR OFFICE
//�USE
�ONLY
Safety Inspection date �VI1FNl L-0 Pass Fail
VDH Food Service (irnecessarY7
Note•,:
2ndinspection date: Il Ou p. []Fail
EAW[plan ❑ Panting , Q ID
Date: ZIP"
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