HomeMy WebLinkAboutHS202100033 Approval - County 2023-02-01&0z,1 --33
Homestay
Zoning Clearance Application
Albemarle County
Community Development
( 401 McIntire Rd., North Wing
Charlottesville, VA 22902
Phone 434.296.58321 Fax 434.972.4126
Submit this completed application with the followin Application fee: $173.76
$ online or to the address above: Applirat $119+TK!vw gV y,r W$476•I,spKtp SW
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
ReRdoritYPntudtM by -right on rural ralrcels ofless than 5 acres rmyhaw 2guest bednxxre by-rght UWof occessorystructures (if buik6eforeAugust 7, 20191 is
parcels of5+oars. Whole house rental isontypermittedon oral area rarcelsof 5+aaes
ADDRESS:
lass
e,
CITY. STATE. ZIP:
�cyl
Sv. ti �. lfra_ aa� la
TAX MAP PARCEL (IF KNOWN);
�y� qV ll O ZONING (IF KNOWN:
Y�J-L I
ADVERTISED NAME OF HOMESTAY(IF APPLICARLEJ:
Gycst Coi+w �:a+l
¢. $�++(1.t �fq ACREAGE OF PARCEL
NO.OF GUEST BEDROOMS:
_)
USING ACCESSORY STRUCTURES?
❑ YES ❑ NO
WHOLE HOUSE RENTAL?
❑ YES
J&NO
2 property Owner/Operator Information
NAME-
{� ) -_---- --
HOME ADDRESS: IAg —I ` for Cw
CITY. STATE, ZIP: Ec,.rk .v�,l R U4. D3,1 3 o
PHONE NUMBER: EMAIL— r n`asdc w h0
'--•�95 -R�17
C- 43'4-89.z-334(0
3. Responsible Agent Information
The responsible agent must be available within 30 mills of the homesteyotall times duff-homestayuse, and merit respond and attempt ingoadfaith to
M$Dtvemryranptaints within 60 minutesof beirtg contacted.
NAME:
HOME ADDRESS: (a 18- Pun
r r\r Cl
CITY, STATE. ZIP. OuJ-------
�<93
PHONE NUMBER: 2t3z{ -aqS _ •�2I} EMAIL
r n(cjr(�e5 c ahau r oM
4.Signature Hay -ggd' 33,f
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 un erstand them, and that I ' I abide by them.
SIGNATURE: •"�^— DATE: t I K 23
FOR OFFICE USE ONLY
Fee Amt $169+4% Date Paid: I Safety inspection date: ❑pass M4,11 2nd impecbon date:
Receipt#
Ck#: __—
Received by:
HS#
VOH Food Service (it necessary):
Notes:
g4optni
RevW.A By
Date: l'i
oral
1:J IU
Denied