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HomeMy WebLinkAboutHO202300042 Affidavit 2023-03-22' APPROVED -v ap Albemarle county Homestay Dythe AibemarleCounty �Jy'r Community Development - m 401 McIntire Rd., North Wing Community Development Depa harlottesville,VA22902 Zoning Clearance Appfi ation D ��—`Ire,;,>' hone44.29658321 Fax 434.972.4126 File Applicationfee: $173.76 Submit this completed applicationwiththe followingonljneortothe address above: MVfic2UonS119+Technolosy5urchage$4.76+Inspection$so 1. Floor plan/property sketchwith 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 formsof verificationcif 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 bythe Zoning Administrator) 1. Homestay Information Residentially zwedand rural area parretsofliess tharl5arses naiyhave2guest bedroom, by -right Use ofaccessarystraciafes(rfbuitteefarekwust ZO is ) 7 19 onlyPen:Wiledby-r"�frt Cut rural area uii U`.rii wii-�. vvnurenrrrbererriurhoruy µTrirrcixxi urtrwaiareu tiwCHS Uf .ri: ,:uo. ADDRESS: LO J bzl . t 9--0 CITY, STATE, ZIP: vJ i c.t< 22 TAX MAP PARCEL (IF KNOWN} ZONING (IF KNOWN): ADVERTISED NAME OF HOMESTA! (IF APPLICABLU: ACREAGE OF PARCEL: NO. OF GUEST BEDROOMS: : USING ACCESSORY STRUCTURES? J ❑ YES El NO WHOLE HOUSE RENTAL? ❑ YES NO 2. Property Owner/Operator Information NAME: a/J "/ �-G�i� S-31 LJGSf 1-.2- HOME ADDRESS: CITY, STATE. ZIP: y5 YJ t c- VA 22- PHONE NUMBER: (> � _ 3 - 0 30 EMAIL: S IJ�.vl tt-�J!" 1Mar �i Yut�u•C,.,. 3. Responsible Agent Information Theresponsibleagent mastbeavadabkwiffim 3o mules ofthe homestayatalitimesduringa homesfny use, andnlust respondandattempt ingood faith to re5aive rHry CGrnyai]ds sYiYfiili 60ruinatoaf Leirrg eurrfa[ied. NAME: l m4r10 HOME ADDRESS: j c5 L° v-IISA CITY, STATE, ZIP: 22 cj PHONE NUMBER: _ 6n _3q7-c j EMAIL• L y e" 1Mo..elCa., r4o •<_e r.i` 41. Signature Ihereby apply forapprovaltocatductiitehomesWidentified abave,and eerti6ythatthi; the property orthart I have recieved a special exceirtirintO Operate the homestay as a resident manager. Ialso certify f iatIhave read the restrictions on homeskays, that I undpp-4dod #Igm,,pnd that t void abide bvthem- Fe-A.mt: S169 + 4% Date Paid: Rece;Pt Ck,Y Received by: H54 _. -- n- -- — . CAT': 16 FOR OFFICE USE ONLY Salery irl-=Vort date: ?,-1 z( ❑ Pa;s ❑ Fa;: 2nd !n;pe:tion datc: ❑ Pass ❑ Fa:f VD H F-3nd SeMre pt necesery}. Notes oarplan ParY.fig .B1[� Reviewd By: G-Approved © Denied