HomeMy WebLinkAboutHS202200070 Approval - County 2023-02-20;uaw>,edaa;uauldofanaa4unwLub-111
Albemarle County
Community Development
Homestay Aiunoo a!lewaq!yay; At) Co munittire De cloporth Wing
;oadd�CharlottesviRe,VA22902
Zoning Clearance Applicatic� f Phone 434.296.58321 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following online or to the address above, APPlkauon$us+Teu.wloarsn.harre$4.76+lmpWi $50
1. Floor plan/property sketch vvith labeled structures used for the homestay, guest bedrooms, owner's bedroom, outdoor lighting
and slgnage for the homestay, labeled setbacks, and parking (minimum 2+ I spottguest 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 Zoni ng Admi nistrator)
1. Homestay Information
Resldentiallyzonedandrural area parcels of less than5 acres my have 2guest bedrooms by -right. Use of accessorystructures III built bef rreAugust 7, 2019) is
ontypermitted by -right on rural area parcels of 5+ acres. Whole house rental is only Permitted on rural area parcels of 5+acres.
ADDRESS:IU�y
CITY, STATE, ZIP.
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TAX MAP PARCEL (IF KNOWN):
O(pcA -�
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ZONING BF KNOWN):.
ADVERTISED NAME OF HOMESTAY.(IF APPLICABLE);
,� -fl Q !L, 'Y) G,no r-
ACREAGE OF PARCEL.:
NO. OF GUEST BEDROOMS.
USING ACCESSORY STRUCTURES?
1 ❑YES �NO
I WHOLE HOUSE RENTAL?-
OYES 3"F10
2. Property Owner/Operator Information
NAME:
HOMEADDRESS:
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CITY, STATE, ZIP.
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PHONENUMBER:
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EMAIL!
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3. Responsible Agent Information
The responsible agent mustbe avoltable within 30 miksof thehomestoyatan times duringahomestayuse, arMmust respondandottempt ingood falth to
resolve ony complaints within 60 minutes of beinfroontacted.
NAME: -!
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HOMEADDRESS:
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CITYSTATE.ZIP:-
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V I'L 7- 'J
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PHONE NUMBER.
4. Signature V 11201 )1 'a� I)
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I hereby apply for approval to conduct the homestay identified above, and certify that this address is my legal residence, and that 1 own
the property or that I have recieved a special exception to operate the homestay as a resident manager. I also certify that 1 have read the
restrictions on homestays, that 1 and stany them, and that I a t'de by them. t/
SIGNATURE y rr :DATE:..
FeeAmO$169+4% Date Paid
Receipt a:
CkX.
Received by:
H 5 P
FOR OFFICE USE
))��ONLY
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Safetyinspecdon tlate: Il'Z.Z'%iL1.l Pass ®Eaif 2nd inspection date ��)�'(, ass OFail
VDH Food Service(if necessary). //��' ❑ Floorplan�OID
Notes. Reviewd By. Date: Z.r
Approved E] Denied
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