HomeMy WebLinkAboutHO201300147 Legacy Document 2013-08-28FOR OFFICE USE ONLY HO # 201 -M
Fee AmOnnt $ Date PaidU'+,)3By who? U{i) I , Receipt 1! I�T C0 10By:
Application for
k
Gass A Home Occupation Clearance
❑ Home Occupation Class A Clearance= $25.00
r_1 Certification that notice of this application has been provided to the property owner, if owner is different
from applicant.
Home Occupation, Class A: An occupation, not expressly prohibited by section 5.2, conducted for profit within a dwelling
unit solely by one or more members of the family residing within the dwelling unit; provided that nothing herein prohibits the
occupation from engaging other persons who work off-site and do not come to the dwelling unit to engage in the occupation.
Name of Business:
Type of Business:
Tax map and parcel: lJ u-4 Zoning: �I V ` r�rV�lll�dLJ��X
Contact Person (Who should we call/write concerning this project?):
Address 3Z('9 City
Daytime Phone \ r Fax # L_)
State ` Zip E" L) r 1
E-mail
Owner of Record
Address City State Zip
Daytime Phone (�
Fax # L_)
E-mail
This certificate, in conjunction with a business license, represents zoning approval to conduct the Class A Home.Occupation
identified above. Each home occupation is subject to the following:
PLEASE CHECK EACH BOX SO THAT IT IS CLEAR THAT YOU HAVE READ AND
UNDERSTAND THE REQUIREMENTS FOR THIS CLEARANCE
LOCATION & AREA
The home occupation shall be conducted entirely within the dwelling unit, provided that not more than twenty-five
(25) percent of the gross floor area of the dwelling unit shall be used for the home occupation and further provided
that the gross floor area used for the home occupation shall not exceed one thousand five hundred (1500) square feet.
[Section 5.2 (b) 1)]
C EXTERIOR APPEARANCE
There shall be no change in the exterior appearance of a dwelling unit or other visible evidence of the conduct of a
home occupation. [Section 5.2 (c)1)]
SALES
No home occupation shall sell goods to a customer who comes to the site except for goods that are hand-crafted on-
site and goods sold that are directly related to a beauty shop or a one -chair barber shop home occupation.
[Section 5.2 (d)]
County of AIbemarle Department of Community Development
401 McIntire Road. Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
7/1/2011 Page 1 of
G� TRAFFIC
CC The traffic generated by a home occupation shall not exceed the volume that would normally be expected by a
dwelling unit in a residential neighborhood. [Section 5.2 (e)]
14, PARKING
All vehicles used in a home occupation and all vehicles of customers, clients or students shall be parked on-site.
[Section 5.2 (f)]
PERFORMANCE STANDARDS
The home occupation shall comply with the performance standards in section 4.14. [Section 5.2A (k)]
Does the use involve prOCedures� machinery Or chemicals that may cause the following?
YES NO
NOISE
VIBRATION
GLARE
HEAT
AIR POLLUTION
WATER POLLUTION
RADIOACTIVITY
_ELECTRICAL DISTURBANCE
NON-DOMESTIC WASTE DISCHARGED TO A SEPTIC FIELD OR SEWER
If YES, then applicable standards must be addressed with a Certified Engineer's Report (available from staff).
4PROHIBITED USES
The following uses are expressly prohibited as home occupations: (1) tourist lodging; (2) nursing homes; (3) nursery
schools; (4) day care centers; and (5) private schools. [Section 5.2 (h)]
WAIVERS AND MODIFICATIONS: The above standards are eligible for waiver or modification by the Planning
Commission. Ask staff for more information about applicable fees and process. [Section 35 and Section 5.1]
Owner/Applicant Must Read and Sign
I hereby apply for approval to conduct the Home Occupation identified above, and certify that this address is my legal
residence. I also certify that I have read the restrictions on Home Occupations, that I understand them, and that I will abide
by them.
Signature of O n /Applicant
ENGINEER'S REPORT ATTACHED: YES NO
CONDITIONS:
�2-b+_,_3
Date
Daytime phone number of Signatory
Date
7/1/2011 Paget oft
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LA OWNER
This form must accompany zoning applications (Home Occupation, Zoning Clears ce, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that
of the application,
[County applicati n name and number]
was provided to \ the owner of record of Tax Map
[name(s) of the ecord owners of the parcel]
and Parcel Number bdelivering a copy of the application in the
manner identified below:
Hand delivering a copy of the appl ation to
person; if the owner of record is an en 'ty, is
title or office for that entity]
on
Date
e of the record owner if the record owner is a
the recipient of the record and the recipient's
Mailing a copy of the application to \
[Name of the re ord owner if the record owner is a person;
if the owner of record is an entit , identify the recipien f the record and the recipient's title or
office for that entity]
on / to the following addr s\
Date
[address; written notic • mailed to the owner at the last known addr ss of the owner as shown on
the current real estat tax assessment books or current real estate tax ssessment records satisfies
this requirement].
Signature of Applicant
Print Applicant Name
Date
J