HomeMy WebLinkAboutHS202300005 Application 2023-01-10Homestay
Zoning Clearance Application
bmit this completed application with the following online or to the address above:
tFAy Albemarle County
'r2 Community Development
•=)• t< 401 McIntire Rd., North Wing
�;4 :r� Charlottesville, VA 22902
rrrxa�t* Phone 434.296.58321 Fax 434.972.4126
Application fee: $173.76
Application $119. Techrolpgy, Surcharge f476. Imla'ctlm $50
Floor Plan/property sketch with labeled structures used for the homestay, guest bedrooms, owner's bedroom, outdoor lighting
and signage for the homestay, labeled setbacks, and parking (minimum 2+ 1 spot/guest bedroom).
Copies of two forms of verification of residency (one government issued with photo ID +one listing the address - acceptable forms
include driver's license, voter registration card, U.S. passport, others as approved by the Zoning Administrator)
Homestay Information
Residentially zoned and rural area parcels of less than 5 acres may have 2 guest bedrooms by -right Use ofaccessorystructures (if built beforeAugust 7, 2019) is
only permitted by -right on mrol area parcels of 5+oces. Whole house rental is only permitted on rural area parcelsof S+apes.
ADDRESS: 1t•Fbs 11`Owll`�
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CITY, STATE. ZIP: l.� IAr•IO4tS iIIe— VA •l'i
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TAX MAP PARCEL (IF KNOWN): `—pZ—OO—GIkIOO
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
I N
ACREAGE OF PARCEL:
O2.S
NO.OF GUEST BEDROOMS:
I
USING ACCESSORY STRUCTURES?
❑YES i$NO
WHOLE HOUSE RENTAL?
❑YES �NO
2. Property Owner/Operator Information
NAME. ML he AnJitirsmS�
HOME ADDRESS: I ;- Wilil w L6t Ice° 0rl1/2.
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CITY, STATE. ZIP: Ck hr
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PHONE NUMBER: �. bl— I�V—OV l6 _ EMAIL Y)U(,C0606) i ,(,a
3. Responsible Agent Information
The responsible agent must be availablewithin 30 miles of the homestay atoll timesduring a homestay use, and must respond and attempt irl faith to
resolve anywmplaints within 60 minutes of being contacted.
NAME: (-
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YV 110� O rt itQ.ZIP:
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YIIStICV Li.0101BER:
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_ bG� IZQ— O� l O EMAIL: I[J t4O,t� C oY a y trTRr �.�om
4. Signature
1 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.
I I DATE
SIGNATURE: _ _ _ E: (D1 /6 1 Z�
FOR OFFICE USE ONLY
Fee Amo $169 . 4% DatePad. Safety inspection date: ❑ Pass ❑ Fad 2nd inspection date: ❑ Pau ❑ Fail
Receipt C VDH Food Service V necessary) : ❑ RwMLan ❑ Parking Cl ID
Cke Notes: Reviesvd By
Received by. Date:
HSa ❑Approved ❑Denied
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