HomeMy WebLinkAboutHS202200060 Approval - County 2023-04-12Homestay
Zoning Clearance Application
air Albemarle County
t 2 Community Development
is 401 McIntire Rd., North Wing
f�.-: �,. Charlottesville, VA 22902
I>Ma5" Phone 434.296.5832 i Fax 434.972.4126
Application fee: $173.76
Submit this completed application with the following online or to the address above: Applivitlonsv9+T«hnowrrStxcha.ee$4.76anspwtion$50
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 accessorystructures (if built before August 7, 2019) is
onlypermitted by-righton rural area parcels of 5+0cres. Whole house rentat is only permiftedon rural area parcels of 5+acres.
ADDRESS:
�Ij c,-GQ f r
✓c
CITY.STATE.ZIP'.
TAX MAP PARCEL (IF KNOWN)z
ZONING (IF KNOWN):
ADVERTISED NAME OF HOMESTAY(IF APPLICABLES:
ACREAGE. OF PARCEL:
�./
NO.OF GUEST BEDROOMS:
USINGACCESSORY STRUCTURES?
❑ YES
:O
WHOLE HOUSE RENTAL?
❑ YE5 f�1 O
J
2. Property Owner/Operator Information
NAME:
HOME ADDRESS:
CITY. STATE. ZIP. Z 2-93
PHONE NUMBER: cJ?i i/ 2) % 1. 7 7 h EMAIL: f (1k) Jm G. J / ru
3. Responsible Agent Information
The responsible agent must be available within 30 mfesof the homestay atoll times during a homestay use, and must respond and attempt in good faith to
resalveany complaints within 60minutesof beingcontacted.
NAME: `> n JAC
HOME ADDRESS
CITY, STATE, ZIP:
PHONE NUMBER:
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 1 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 1 yQderstand them, and that I)Vill abide by thean.
SIGNATURE ( O J{/4�6;.4.AArl W. ?,_ �. i I DATE: ILam'-
Fee Amt'$169+4% tDate Paid
Receipt #:IQ�_—__���__
Ck#: () 1!-f
Received by: Q�
FOR OFFICE USE ONLY
Safety inspection date: � ❑ P:rss XFaIl
VDH Food Service (if necessary):
Notes:
2nd inspection date:, ss ❑ Fai
Rev+ewd By. 1e""Pt L_
j'Approved - Q Denied