HomeMy WebLinkAboutHS202200072 Approval - County 2023-01-26APPROVED
by the Albemarle County
Community Development Department
Homestaate
File
Zoning Clearance Application
Albemarle County
? "'y
Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
�'rraiys r. Phone 434.296.58321 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following Qatim or to the address above: Appli tun $119+ TecMobgy surdu $4.76+Impec m$5a
I. 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 spottguest 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
Residentiailyzonedand mml areaporcels of less than 5 acres may have 2guest bedrooms by -right Use of accessorystructures (if built before August 7, 2019) is
onlypermittedby-righto mmiarmparceis of5+acres Whok house rentallsontypermittedonmmlareaprucels of5+aces.
ADDRESS: 4? 1 y :c?/ _ /_:---"-
CITY, STATE. ZIP:
TAX MAP PARCEL (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
NO. OF GUEST BEDROOMS: USING ACCESSORY STRUCI URES' 0YE` ®'NO
2. Property Owner/Operator Information
NAME: /
HOMEADDRESS: " -O
CITY. STATE. ZIP.
PHONE NUMBER:
3. Responsible Agent Information
EMAIL
ZONING (IF KNOWN:
ACREAGE OF PARCEL
WHOLE HOUSE RENTAL? ❑ YES JQ NO
f//l I"O/Z LG. 0,1
Theresponsibkagmt must beovalloble within 30 miles of the homestay atoll times duringahomestoy use, and must respondandattempt ingoodfadh to
resohr. anYcomploints within 60 minutesof beingcontocted.
NAME:
HOME ADDRESS:
CITY. STATE, ZIP:
PHONE NUMBER:
7-
7S/7- ;72-1/ I EMAIL:
4. Signature / l�jsr-ro
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
SIGNATURE: y
restrictions on homesta s, that l understand, and that l will abide by them.�-_--- DATE:
FOR OFFICE USE ONLY
Fee Amt: s169 + 4% Date Paid: Safety inspection date: Z —Z 0 Pass ail 2nd inspectxrn date' Zi Z
❑Pass aii
Receipt it VOH Food Service (fi necessary): � _.,
fg'Floorplan wrung. 1211
Received by.
Reviewd By _ '
HSit
Approved 0 Denied