HomeMy WebLinkAboutHS202300004 Application 2023-01-09Homestay
Zoning Clearance Application
fi ^rn,., Albemarle County
Community Development
e .. =f - ` 401 McIntire Rd., North Wing
Charlottesville, VA 22902
�,�7�rcayC.r Phone 434.296.5832 1 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following online or to the address above: Apallcatlen$u9+Technology Surcharge $a.7e+Inspection $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
Residentioly zoned and rural area parcels of less than 5 acres may have 2 guest bedrooms by -right Use of accessorystructures (if built beforeALWst 7, 2019) is
rveh,nmwittcd bvrisht on rural area parcels of 5+acres. Whole house rental is only permitted on rural area parcels of 5+acres.
ADDREss:
697 Ivy Depot Rd.
rtTv,SrnTE,zIP:
I Charlottesville VA 22903
TAX MAP PARCEL (IF KNOWN):
058A2-00-00-0IOA0
ZONING (IF KNOWN):
VR
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
Hornetract Cottage
ACREAGE OF PARCEL-
3.2
NO. OF GUEST BEDROOMS:
I
USING ACCESSORY STRUCTURES?
❑ VES ® NO
WHOLE HOUSE RENTALS
❑YES NO
2. Property Owner/Operator Information
NAME: Austin and juh Gerken
HOME ADDRESS: 699 Ivy Depot Rd.
CITY, STATE. ZIP: Charlottesville, VA 22903
PHONE NUMBER: RM-337-7238
EMAIL:
3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay at all times during homestay use, and must respond and attempt in good faith to
resolve arty complaints within 60 minutes of being contacted.
NAME: Austin and Juli Gerken
HOMEADDRESS: 699 Iw Depot Rd.
OTY, STATE. ZIP: Charlottesville, VA 22903
EMAIL:
PHONENUMBER: 828-337-2238 -
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. — DAie i"— G —d—
SIGNATURE:
FOR OFFICE USE ONLY
❑Pass ❑Fail 2nd inspection date:
❑ pass Fait
Fee Amt$169+4% Date Paid:
Safety inspection date:
❑Floorplan
❑Parking ❑ID
VDH Food Service (if necessary):
Receipt d:
Reviewd BY:
Notes:
Ck#:
Date:
Received by:
Approved
Denied
Hsu