HomeMy WebLinkAboutHS202000028 Application 2023-01-26Homestay
Zoning Clearance Application
Submit this completed application with the following online or to the address above:
Albemarle County
Jlv 'if ' Community Development
1 401 McIntire Rd., North Wing
Charlottesville, VA 22902
Phone 434.296.5832 i Fax 434.972.4126
Application fee: $173.76
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 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 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:
2I V / — G
CITY, STATE, ZIP:
��. 4 -- l
a
TAX MAP PARCEL (IF KNOWN):
0 q 0 0 (o o
/
1�
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE): , ,
tl
e ACREAGE OF PARCEL: '�
c j 0 y,
NO. OF GUEST BEDROOMS: USING ACCESSORY STRUCTl1RES?
❑ YES
❑ NO WHOLE HOUSE RENTAL? ❑ YES mltl�o
2. Property Owner/Operator information
NAME: - -
--- e C� i f L1 ZJ
HOME ADDRESS:/
v S ✓ d `.
CITY. STATE, ZIP:
-� �� C 3 7
PHONE NUMBER:E7yy�C.S-�
C: a
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: e� 1e `FlJL
HOME ADDRESS: e
CITY. STAI-E, 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 I have read the
restrictions on homestays, that I undeys4and thetn7dRfl that I willabToe by them.
SIGNATURE:
Fee Amt: $169 + 4% Date Paid:
Receipt #:
Ck#:
Received by:
HS#
FOR OFFICE USE ONLY
Safety inspection date: ❑ Pass ❑ Fail
VDH Food Service (if necessary):
Notes:
DATE:
2nd inspection date:
❑ Floorplan
Reviewd By:
Date:
0
❑ Pass []Fail
❑ Parking ❑ ID
Approved Denied