HomeMy WebLinkAboutHS202300005 Application 2023-01-09Homestay
Zoning Clearance Application
bmit this completed application with the following online or to the address above:
sf 4Le,.r Albemarle County
ryE Community Development
-(� r< 401 McIntire Rd., North Wing
�;; '� Charlottesville, VA 22902
rrMP>t" Phone 434.296.58321 Fax 434.972.4126
Application fee: $173.76
ApPlkatlon $119. Techrolory Surcharge $4,76+ ImPli $50
Floor Plan/property sketch with labeled structures used for the homestay, guest bedrooms, owner's bedroom, outdoor lighting
and signage for the homestay, labeled setbacks, and parking (minimum 2+ 1 spot/guest bedroom).
Copies of two forms of verification of residency (one government issued with photo ID +one listing the address - acceptable forms
include driver's license, voter registration card, U.S. passport, others as approved by the Zoning Administrator)
Homestay Information
Residentially zoned and coral area parcels of less than Scores may have 2 guest bedrooms by -right Use of occessorystructures (if built before August 7, 2019) is
only permittedby-eighton clam' l area parcels of 5+acres. Whole house rental is only permitted on rural area parcels of 5+aces. j
ADDRESS:
CRY, STATE. ZIP: E'YIt\Y-'IDT"ffS IIIQ. VA 2-?00?
IV C�
TAX MAP PARCEL(IF KNOWN): �,1 F,—pZ-OO—GI40O
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAYIIF APPLICABLE):
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ACREAGE OF PARCEL:
OLS
NO.OF GUEST BEDROOMS: I USING ACCESSORY STRUCTURES? I DYES 1KNO WHOLE HOUSE RENTAL? ❑YES jffNO
2. Property Owner/Operator Information
NAME. IAL hC AnJIL( SQ
HOME ADDRESS: I S W ow LAICe O rl \re.
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CITY. STATE. ZIP: Ll1hr IO IT�sV111e 2,2`tU Z.
PHONE NUMBER: �. OI——'$()�� _ EMAIL. IOkLK(06D®r/_
3. Responsible Agent Information
The responsible agent must be ovailablewithin 30 milesof the homestay atoll timesduring a homestay use, and must respondand attempt ingood faith to
resolve anycomplaints within 60 minutes of being contacted.
NAME: L r. � .1',
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HOME ADDRESS: YV I fl p I—c O n tr Q,
CITY, STATE. ZIP: L Hr,o Apr5V-AtIIt V Ilct 01
PHONE NUMBER'. bV�— IZ�= Od l 0 EMAIL:
b1.4 C oYS6 `r C6rh
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.
0.E:
SIGNATU_ _ _ _ _ _ DATE. O' /6 1 /2�
FOR OFFICE USE ONLY
Fee Ame $169 . 4% Dale Pald'. Safetyinspection date: ❑ Pass []Fail Ind inspection date: []Pass []Fail
Receipt I. VDH Food Service 61 necessary} ❑ Floorplan ❑ Parking ❑ ID
Car Notes: Reviewd By
Receired by. Dale:
HSa ❑Approved ❑Denied
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