HomeMy WebLinkAboutHS202300018 Application 2023-03-28Homestay
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Zoning Clearance Application
of^r Atbemarte County
Community Development
401 McIntire Rd., North Wing
Charlottesville, VA 22902
�rA�Ntr Phone 434.296.5832 1 Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following online or to the address above: APpllr ion $119+Teahnology5urcherge$4.76+hsspection$5o
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 parcels of less than 5 acres may have 2 guest bedrooms by -right Use of occessory structures (if built before August 7, 2019) is
only permitted by -right on rural area parcels of 5+acres. Whole house rental is onlypermitted on rural area parcels of 5+acres.
ADDRESS:
1 1193 Woodlands Road
CITY, STATE, ZIP:
I Charlottesville, VA 22901
TAX MAP PARCEL (IF KNOWN):
04300-00-00-032GO
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY (IF APPLICABLE):
ACREAGE OF PARCEL:
t--
1.68
NO. OF GUEST BEDROOMS:
1
USING ACCESSORY STRUCTURES?
❑ YES ® NO
WHOLE HOUSE RENTAL?
❑ YES ® NO
2. Property Owner/Operator Information
NAME:
Kyle Lewis
HOME ADDRESS:
1193 Woodlands Road
CITY, STATE, ZIP:
Charlottesville, VA 22901
PHONE NUMBER:
434-981-4587
EMAIL
klewis@virginia.edu
3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestay at all times during a homestay use, and must respond and attempt in good faith to
resolve any complaints within 60 minutes of being contacted.
NAME:
Kyle Lewis
HOME ADDRESS:
1193 Woodlands Road
CITY, STATE, ZIP:
Charlottesville, VA 22901
PHONE NUMBER:
434-981-4587
EMAIL:
klewis@virginia.edu
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 abide by them.
SIGNATURE: w/�-p /-4zV1W- I DATE: 124 March 2023
v_ FOR OFFICE USE ONLY
Fee Amt: $169 +4% Date Paid: Safety inspection date: ❑ Pass ❑ Fail 2nd inspection date: ❑ Pass ❑ Fail
Receipt #: VDH Food Service (if necessary): ❑ Floorplan ❑ Parking ❑ ID
Ck#: Notes: Reviewd By:
Received by: Date:
HS# E] Approved r-1 Denied