HomeMy WebLinkAboutHS202300018 Approval - County 2023-04-12Homestay
Zoning Clearance Application
`��+•"-q,� Albemarle County
Community Development
i^ 401 McIntire Rd., North Wing
Charlottesville, VA 22902
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: Appliubw$119+T«hrolMS,r,h.,e$4.76+l,vpat;onsso
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
Residentially zoned and rural area parcels of less than 5 acres may hove 2guest bedrooms by -right. Use of accessory stnx:tures (if built before August 7, 2019) is
only permitted by-r4hiton rural area parcels of 5+0cres. 4Ylrole house rentalisonlyperri tted on rural arm parcels of 5+acres.
ADDRESS:
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 HOMESTAV (IF APPLICABLE):
ACREAGE OF PARCEL:
1_68
NO. OF GUEST BEDROOMS:
1
USING ACCESSORY STRUCTURES?
❑ YES ® NO
WHOLE HOUSE RENTAL?
❑ VES ONO
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:
kiewis@virginia.edu
3. Responsible Agent Information
The responsible agent must be available within 30 miles of the homestayot all times duringo homestoy use, and must respond and attempt ingood faith to
resolve any complaints within 60 minutes of being contacted.
NAME:
Kyle Levels
HOME ADDRESS:
1193 Woodlands Road
CITY, STATE. ZIP:
Charlottesville, VA 22901
PHONE NUMBER:
434-981-4587
EMAIL:
kiewls@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: �y DATE:
24 March 2023
FOR OFFICE USE ONLY
Fee Amt$169+4% Date Paid: Satety inspection date: 4(o [Vass []Fail 2nd inspection date: ❑Pass ❑Fail
Receipt #: VDH Food 5ervke (if necessary): Floorplan Parking _ , ID
Ck#: Notes: Reviewd By:
Received by: Date: �f
HS#
Approved Denied