HomeMy WebLinkAboutHS202300013 Application 2023-02-10Albema
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ty
Homestay z2 "aa CommunryDevel p
�. , .� Community Development
401 McIntire Rd., North Wing
Zoning Clearance Application * Charlottesville, VA22902 \ nnaN r Phone 434.296.58321 Fax434.972.4126
Application fee: $173.76
Submit this completed application with the following gl hLiQ or to the address above: Appl u.. $uv.Tech w[� wn:h. ;. 1W.76.1.s� ion $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 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
Residentiallyzoned and rural area parcelsofless than 5 acres :mayhave 2uuest bedrooms by -right. Use of accessorystructures (if built before August 7, 2019) is
only permitted by -right on rural area parcels of5+acres. Whole house rental is onlypermittedonruralareaper lsof S+acres.
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CITY. STATE ZIP.
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TAX MAP PARCEL(IF KNOWN):
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
ACREAGE OF PARCEL:
, Z5
NO.OF GUE5T BEDROOMS: _
2
USING ACCESSORY STRUCTURES?
❑ YES ,ENO
WHOLE HOUSE RENTAL?
❑ YES J'NO
2. Property Owner/Operator Information
NAME: .._ �U y (
HOMEADDRESS: + `Z e-[4 ECSL
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CITY, STATE. ZIP: C'6, D (I v!T
i PHONE NUMBER — O _ Z EMAIL:
3. Responsible Agent Information C0 WI
The responsible agent must be available within 30 miles of the homestay, atoll times during a homestay use, and mustrespond and attempt in good faith to
resolve anycomploints within 60 minutes of being contacted.
NAME: \ /I l In �. r. =naA 1
1 " V1 VI vV\V1 I�Y'r•t _ _�
HOME ADDRESS. Mn -1 I-P— 1 r f
lil F
CITY. STATE, 71P
PHONE NUMBER�t�Zr EMAIL VeIA vo,VIe—I (2�
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 understand them, and that I will a by them.
SIGNATURE:
Fee Ant: $169 = 4% Date Paid:
FOR OFFICE USE ONLY
Safety inspecfioo date:.—_ ❑ Pass Fail 2nd inspection dare:
Receipt#: V X 1 Food Serwe V
Ckif __ Notas:
Received by:
HS#
❑ Honrplan
Reviewd By
Oafer
[] Approved
[IPass ❑Fail
❑ Parking ❑ ID
❑ Denied
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County of Albemarle 125867
Department of Community Development
PH: (434) 296-5832 Date
RECEIVED FROM:
AMOUNT:
For:
"t- % to 51
check
cash
credit card
By