HomeMy WebLinkAboutHS202300003 Application 2023-01-05Homestay
Zoning Clearance Application
oaf nr.�e Albemarle County
S Community Development
- 401 McIntire Rd., North Wing
Charlottesville, VA 22902
"rxclH�"' Phone 434.296.5832 1 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following or jue or to the address above: Aaplirauoestl9-Technology Surcharge $476+lnsP il$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
Residentially zoned and rural area parcels of less than 5 acres may have 2 guest bedrooms by -right. Use of accessory structures (if built before August 7, 2019) is
only permitted by -right on rural area parcels of 5+acres. Whole house rental is only permitted on rural area parcels of 5+acres.
ADDRESS:�\��
CITY, STATE, ZIP: t- VAC Sy `` - �f a.017\ a3
TAX MAP PARCEL (IF KNOWN): I I ZONING (IF KNOWN): I I
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE): ACREAGE OF PARCEL:
NO. OF GUEST BEDROOMS: I I USING ACCESSORY STRUCTURES? I ❑ YES ❑ NO WHOLE HOUSE RENTAL? I IrYES ❑ NO
2. Property Owner/Operator Information
NAME: \J� l cic. Q Q�
HOME ADDRESS:
CITY, STATE, ZIP:
PHONE NUMBER: ✓ 1 qG5 —CA-�)3 EMAIL:
3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay at all times during a homestay use, and must respond and attempt in good faith to
resolve any complaints within 60 minutes of being contacted.
NAME:
r
HOMEADDRESS:
CITY, STATE, ZIP:
exxvao ..rSv \\\.e ( 'v'A p,
PHONE NUMBER:
92l1:
.2tf 2. -C(!Wa
EMAIL:
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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:
Fee And: $169+4% Date Paid:
Receipt#:_
Ck#:
Received by:
HS#
FOR OFFICE USE ONLY
Safety Inspection date: ❑ Pass ❑ fail 2nd inspection date:
VDH Food Service (if necessary): ❑ Floorplan
Notes: Reviewd By:
Date:
❑ Approved
[]Pass []Fail
❑ Parking ❑ ID
Denied
I.1
11