HomeMy WebLinkAboutHS202100021 Application 2023-01-17Homestay
Zoning Clearance Application
AWernarte County
Ju Commun@y Development
f 401 McIntire Rd., North Wing
Charlottesville, VA 22902
Phone 434.296.38321 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following or to the address above: Awlitetanslt9+TachrolosvSurcharge $4.764Inspection $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 2guest bedrooms by -right. Use of occessorystrwtures (if built before August 7, 2019) is
onlypamitted by-righton rural area pa Fels of 5+acres. Whole house rental is only permitted on rural area parcels of 5+acres.
ADDRESS:
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CITY, STATE. ZIP:
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TAX MAP PARCEL (IF KNOWN):
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ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAV (IF APPLICABLE):
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ACREAGE OF PARCEL:
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NO. OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES? I ❑ YES 'INLNO
WHOLE HOUSE RENTAL?
I ❑ YES NO
2. Property Owner/Operator Information
NAME:
HOMEADDRE5S:
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CITY, STATE, ZIP:
PHONE NUMBER:
4y _ EMAIL:
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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:
HOME ADDRESS:
CITY, STATE, ZIP:
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PHONE NUMBERLj—%Jy pi1.0 �--�, �.� EMAIL: T� �
4.Signature
I hereby apply for approval to conduct the homestay identified above, and certify that this address is my legal residence, and that 1 own
the property or that I have recleved a special exception to operate the homestay as a resident manager. ) also certify that I have read the
restrictions on homestays, that I understand them, and that 1 will abide by them. .
SIGNATURE: 14 1 DATE:
��Nla.rt. 1 ► � 101 '3
FOR OFFICE USE ONLY
Fee Amt $169 + 4% Date Paid: Safety Inspection date: ❑ Pass ❑ Fail 2nd Inspection date
__— ❑Pass ❑Fail
Receipt a: VDH Food Service (If necessary): ❑ Floorplan ❑ P�,kvg ❑ ID
CIO: Notes Reviewd By:
Received by: Date:
HSr
Approved Denied
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