HomeMy WebLinkAboutHS202200015 Approval - County 2023-02-20APPRQ"ED
by the Albemarle County
Community Development Department
Date
• 1=ilp '�—
Homesta\/ '" Albem'rleCounty
7 Com"aity Development
= 401 Mcintjre Rd., North Wing
Zoning Clearance Application. - CharlotteiWille, VA22902
t Phone 43ii1.296.58321 Fax 434,9T2.4126
Submit this completed application with the followingJi Pplication fee: $173,76
t11111D1:Or ID the address above: Applkaian $119+i Suni3rye$4.76. 1as9ectian ISO
1. Floor Plan/property sketch with labeled structures used for the homestay, guest bedrooms, Owner's bedrcOm. 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 l D+ one listing the ad ress- acceptable forms
include driver's license, voter registration card, U.S. passport, others as approved by the ZOnInR AdministrAtnrl
1. Homestay Information
Residendollyzonedand rural areaporcefsofless than 5 acres may hove 2guestbedroomsbri8 - ht Use accesso
onlYPermitted by -right on ruralarea parcels of5+ saes Wholehouseremal isonl yf tures f(6uiltl August 7,T019)Is
ADDREsst
CITY, STATE. ZIP:
TAX MAP PARCEL (IF KNOWN)
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE).ZONING (IF KNOWN).
ACREAG OF PARCEL
NO. OF GUEST BEDROOMS: USING ACCESSORY ST TURES? ❑YEs ❑ NO WHOLE HOUSE RENT L? B'YES ❑ NO
2. Property Owner/Operator Information �t
NAME
ItOMEADDRESS: C -L
CITY, STATE, ZIP
PHONENUMBER: A-
EMNL
H'V f�tSn,LG.SI
3. Responsible Agent Information
TIN: respomibleagent must be available within 30 miles of the homestayat ail times during a homestayuse, and must respondand atte �
resoN¢arrWmPlatms Within 60 minutes Of being contactedI hpt in good faith to
NAME: _
HOME ADDRESS' �` 1
CITY, STATE. ZIP: �Tr
a tt
PHONE NUMBER: / / 1 7 r r ( EMAIL
----[-�-__
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. 1 also certify that I have read the
restrictions on homestays, that I and tand them, and th i '11 abide by them.
SIGNATURE-,,,t'/ I DATE / /L/I_• _- —.. �I
FOR OFFICE USE ONLY
Fee Aax:$169+4% Date Paid- - Safety inspection date, t'ZZ Z3
❑Pass Dail 2nC insPecta9 date I Pass ❑paA
Receipts' VON Food Service (if necessary). FFp/ I 1f—Jss OF
Ckp: .— rplan tKng
Notes: Revlewd 8y
Received by. _ ---_
-`- pproved Denied
AlliftTAIIIIIIIi. Ali