HomeMy WebLinkAboutHS202300014 Application 2023-02-10Homestay
Zoning Clearance Application
Albemarle County
�a Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
Phone 434.296.511321Faz434.972.4126
Application fee: $173.76
Su bmit ffis completed application with the following online or to the address above: Application$119+ Technology Sorcharge$4.76+lnspectioo$so
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 spotiguest bedroom).
2. Copies of two forms ofver-ficationofresidency (onegovernment issued with photo ID+ one Iistingthe add ress-acceptableforms
i nclude driver's license, voter registration card, U.S. passport, others as approved by the Zoning Administrator)
1. Homestay Information
Residential€yzamd andmra€area parcetsofless chseSaesesoxrf€ras�25uesEbeF{roornsby-r tt€se Ofr�res,eaysFruct¢€ ibefoseRr first 72019/is
an€y irtit�diiy-r(gEti(uirJra€aiea Fruc[$O{`.�i+tiuea. vbritire iirYioeF-eCyjtir`titik• __�<...... _ .._ _ ay{54 rarnauu ucrrurarweu yiuceSuf �-. .h:Eca,
ADDRESS:
1 !�PO La..,.l
CITY, STATE. ZIP:
K,5,-A UK-
J A�-
TAX MAP PARCEL (IF KNOWN):
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE), i
ACREAGE OF PARCEL:
NO. OF GUEST BEDROOMS:
€1
USINGACCESSORY STRUCTURES?
❑YES E60
WHOLE HOUSE RENTAL?
I DYES NO
2 Property Owner/Operator Information
NAME:
HOME ADDRESS:
6565 LCS'A. II F�,
CITY, STATE. ZIP:
PHONE NUMBER:
_76p
� Yam•' c<.
3. Responsible Agent lr•.formation
Theresponsb}eagvttmusl m�ar7abk;vitiiin 30m of3he nornes3ayaTa37 L"raesdurirgahomestnyanz,andraustrespmdandattemptingood faith to
1FSaiYe wiyCairvjrFuil,ii wiiiiiii ov3i3ii]itB.s y`vd.'lfy ua,racied.
NAME:
l /.. _LJCS'�,%-�'
HOMEADDRESS:
5e5 L°uISA
CITY, STATE, ZIP:
,Sy,€ f C.� JA `j- Z 9 -7�
PHONE NUMBER:
_ (�f? `:3 o 3EMAIL:
S (Ye.Sr
e"r •` IMono'C"+ Ya�.2o �-a"^
4. Signature
Ihereby apPtyforappramttoconductffteho-,nesEayidentified above, and ce thatthisau„s---- -- '.
the property orthat € have redeved a special exception to operate the homestay as a resident manager. i also certify that l have read the
restrictions on homestays. that € undeP¢ them.and that t wlll abide bvthem-
1 SIGNAT URi - 1 / i/ \�Y A��'l'�—� i DATE: i 1
FeeAant. $169 +4% Date Paid:
Receipt 5:
FOR OFFICE USE ONLY
52feti insPecfon date: ❑Pass ❑Fai: 2nd insp°rtion date:
VDHFood Servimttfnecesary}. ❑Fborplan ❑Parking
❑Pass ❑Fa
13 ID
Notes:
Received by:
I S r _ .— —_.
Reviewd By:
[] Approved 0 Denied
��oF'tr�r„y Albemarle County
Short -Term Rental Registry9� Community Development
,R 401 McIntire Rd. North Wing
Charlottesville, VA 22902
Annual Application 3�,R�Nr ,�ea�a� 2
Prior to opeltingfor business, all operators of short-term rentals(including homestays and previously approved bed and breakfasts and
accessorytourist lodging rentals) must:
Enroll on the Short -Term Rentals Registry with this form
Obtain an approved zoning clearance (requires VDH and building/fire safety inspection)
Register for a businesslicense andmmitrenuirt;rlf
Annuallyfollowingthe initial approvals; all operators of short-term rentals must:
Renew their enrollment on the registry with this form
• Pass abresafety. insoection
• Renew their business license and remitreauiredtaxes
Fields marked with an -asterisk are the mmimum required for registration.
1. Short -Term Rental Information
A whole housererrial isa shorttermrentalof a hme during ruiudtt.lie ownerisnot recWred to be presettt, VJf
Area parcels of 5+acres, w(efmusererttats areon4ypemtitted on Rural
-APPROVED HOMESTAY (HS), BEDAND BREAKFAST{BNB), OR ACCESSORY
TOURIST LODGNG (ATL) CLEARANCE PERMIT MUM BER(IFppAPPLICABLE):
'ADDRESS:
"CITY.STATEZiPTAX
Tf TZONING(1FKNOWN):
tF��r3
MAPPARCEL(:
GUESTBEDROOMS;
WHOLE HOUSE RENTAL
❑YES `CXIQO
2 Prop
ertyovrnerlOperatorInformation
*NAME: -.. _
�}pyo�++,O S y LUGS % L %L-
`HOMEADDRESS:
O cu.CS-ra
'CITY, STATE, ZIP:
Jt c.-Pc Vc,
PHONE:
4—cl ro0 c`�3
EMAIL-
S �.I �S ra.r• l+wm�sr@� 'Caw.• I
3. Responsible Agent Information
The respan'6leo9patmustheavaiLaWew#1in?QmReso' the homestayataletimes du:btgahom yuse- and must res poi idandatEeWingoodfal€hco
resolve anycomplautisw€€{un66minntesm be[ngcontacteei_
OWNERIOPERATORISRESPONSIBLEAGENT:
I XKES ONO IF NO, COMPLETE RESPONSIBLE AGENT INFORMATION BELOW
NAME;
HOMEADDRE$S:
CITY, STATE, ZIP.
PHONE:
EMAIL -
FOR OFFICE USE ONLY Bate Patti:,-, _/_,J_
FeeAtnt 0$27 0$0withclear2nceapplitatkm
Receipt#: Received br,
Accepted 0 Denied
Registration
www_aihemarla_nre/homesiays v. 9.17.201 Paee1 nf1
G
G-4
P¢as
al5a.
(i7(S' >l
y owe,
�33
Payment Receipt
Your transaction has been successfully completed!!
Your Confirmation number is :
Transactien.n: 230208111904346F�1E202302r811'90
02/08/2023 12:22:50 [EST]
7E728F528AA29BAC649 $173.76
Account Information
Payment Type: Tax Payment
Bill Payer Details
GIMOND Sylvester
5505 Louisa Rd
Keswick, VA22947
Payment Details
Payment Amount: $173.76
Convenience Fee: $4.34'
Total Amount: $178.1n
Payment Method:....
Card !dumber: XXXXXXXXXXXXX9051
Expiration date: 09/2027
bitps:flpforay me nts.albemarle. countytaxes.ory;Rece;pIinIo(Recelptinfo 2/3/23, 12:22 ?,`,:
cans. 1 'f