HomeMy WebLinkAboutHS202300014 Approval - County 2023-02-17APPR01/ED s , -�a�r Albemarle County
Homestay bythe v AibemarleCounty eommunityDevelopment
R C�401 McIntire Rd, North Wing
ommyinity Development Depa Charlottesville, VA 22302
Zoning Clearance Appti;(aabon 'r,Ml>' Phone434.296.5a321 Fax434.972.4126
File
Application fee: $173.76
Submit this completed application with the foilowingonlineortothe address above: APVrKation$119+Technology5urcharge$4.76+laspection$50
1. Floor plan/property sketch with labeled structures used for the homestay, guest bedrooms, owner's bedroom, outdoor lighting
and signage for the homestay, labeled setbacks, and parking (minimum 2+ 1 spot/guest bedroom).
2. Copies of two forms ofverification ofresidency (one government issued with photo ID+one listing the address-acceptableforms
include driver's license, voter registration card, U.S. passport, others as approved by the Zoning Administrator)
1. Homestay Information
Residentially zonedardrumtarea parcdsoflesstharI5aaesmayhave21fuestbEdroomshy-right Useafaccessorystrumre 0fbui(tceforekwust 720 j 19 s
only by-ri$frt urtJ'fllai arenlitlirlii ui.fii ticiih. vvrru,er,4tae rezriui li urriy trcriti[e[xai viirYraiarey ts3rCFfi Crf$;.iuo.
ADDRESS:
S O: bzl � L 9-✓
CITY, STATE, ZIP:
I <Cswi c-K J A e7 Z Z
l� /
TAX MAP PARCEL W KNOWN,.
ZONING (IF ICVL`WN):
ADVERTISED NAME OF HOMESTA! (IF APPLICABLE):
ACREAGE OF PARCEL:
NO. OF GUEST BEDROOMS:
I
USING ACCESSOR'f STRUCTURES?
J
❑YES t7 NO
WHOLE HOUSE RENAL?
OYES NO
2 Property Owner/Operator Information
NAME:
�-G�i� >1 LJGJf E7—P—
HOME ADDRESS:
'` S o j L6 �A I,
CITY, STATE. ZIP:
PHONE NIiv:BER;
6 _30 31,
EMAIL:
S I.;,a..� Pam!• lMur u•G...
3. Responsible Agent Irformmation
Theresponsibleagent must be"a$ablembbin 30 mft of the hamestayafall Smesduringa homestay use, nndmustrespandandattempt ingood faith to
resuive,xry Carrtyiauru wiYribl60m5wiovfi>rityy u,r,f,�ded.
NAVE:
% Iyf ,w,(o S L
HOME ADDRESS:
O� Lo s.tlSA
CITY, STATE, ZIP:
GSA t c-k JA 22 cl
PHONE NUMBER:
_ (.gyp _ ��c
E'sAIL•
S (J2S1
L ��
`-! e" 1MonNCa.+ Yo •<_e r�'�
4. Signature
Ihereby apply forapprovaFtocamducttitehomestityidentified above, and certifythatthis.-o—
the propertyorthat I have redeved a Special exceptionto operate the homestay as a resident manager. C also cerfify I have read
the
restrictions on homestays, that t und�td t1uVri,rared that [will abide bvthem- Etta, I have read the
Fe_A. t: $1.'.9 + 4% Cate Pd'.d:
Re:e:pt »:
Ckt:
Received by:
H9-
CAT': 16
FOR OFFICE USE ONLY
Safer. in.p_,tiart date: l� iz 3❑Pas Ma:' 2nd'.rcpeet'.ondate: ❑Pass ❑Fat
�Y
VDH Food Service Of necearv}.
Notes
oorp;an Pahfig .B1[�
Revievid By:
C3-Approved El Denied