HomeMy WebLinkAboutHS202300006 Application 2023-01-17Homestay
Zoning Clearance Application
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10: SOW
Albemarle County
Community Development
401 McIntire Rd., North Wing
is
Charlottesville, VA22902
Phone 434.296.5832 1 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following online ortothe address above: Application $119+ Technology Surcharge $4,76+Inspection $50
1. Floor plan/property sketch with labeled structures used for the homestay, guest bedrooms, owner's bedroom, outdoor lighting
and signage forthe 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 bythe 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:
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CITY, STATE, ZIP:
136 r
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2 23
TAX MAP PARCEL (IF KNOWN):
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY(IF APPLICABLE):
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ACREAGE OF PARCEL
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NO. OF GUEST BEDROOMS:
USING ACCESSORY STRUCTURES?
I ❑ YES Y NO 7WHOLE
HOUSE RENTAL?
I ❑ YES KNO
2. Property Owner/Operator Information
NAME:
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HOME ADDRESS:
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CITY. STATE, ZIP:
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PHONE NUMBER:
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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.
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NAME:
Ant—L
HOME ADDRESS:
CITY, STATE, ZIP:
PHONE NUMBER:
EMAIL:
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 1 have read the
restrictions on homestays, that I u tand t and that wi a de by them.
SIGNATURE: ht ZL,DATE: /Z ZoZZ
FOR OFFICE USE ONLY
Fee Annt: $169 + 4% Date Paid: Safety inspection date: ❑ Pass []Fail 2nd inspection date: []Pass ❑ Fail t�.l�
Receipt 4: VDH Food Service (if necessary): ❑ Floorplan ❑ Parking ❑ ID ` ` S
Ck# Notes: Reviewd By:
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Received by: Date: v,
HSa ❑ Approved ❑ Denied