HomeMy WebLinkAboutHS202300006 Approval - County 2023-02-01Y9�n1 p, r�'3,y Aj( •�" s,vr^rvu,,,� Albemarle County
Y 0 ® eS 8.a �, Community Development
51=^+ 401 McIntire Rd., North Wing
Zoning Clearance Application T"1 Charlottesville, VA 22902
b MaNs� Phone 434.296,5832 1 Fax 434.972.4126
76
Submit this completed application with the followingApplication fee: s
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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
Residentiollyzoned and rural area parcels of less than 5 acres may have 2guest bedroom 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:
4_[I ' v 14
CITY.STATE,ZIP:
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22—IT `
TAX MAP PARCEL (IF KNOWN):
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABILEY.
ACREAGE OF PARCEL
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NO. OF GUEST BEDROOMS:
7—USE
USING I RU ACCESSORY SCTURES7
❑YES ❑NO
WHOLE.; RENTAL?
)QYFS ON(
2. Property Owner/Operator Information
NAME:
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HOME ADDRESS:
CITY, STATE, ZIP:
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PHONE NUMBER:
„z // [�
EMAIL
3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestayat all times during a homestay use, and must respond and attempt in good faith to
resolve any complaints within 60 minutes of being contacted.
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 ].understand them, and that i y4ilkibide by them.
SIGNATURE:
Fee Amt$169+4% Date Paid:
Receipt
Received by:
HSF
FOR OFFICE USE ONLY
Safety inspection date: ❑Pass ]y,Fail
VON Food Service (if necessary):
(Votes:
DAIS:
2nd ins (ion date:
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Reviewd By:
Date:
❑ Denied
Fail
CCA,