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Application for+,,
Class A Home Occupation Clearance
❑ Home Occupation Class A Clearance = $25.00
F-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: rlorol '� Pirrley O ohee6c2
I
Type of Business: - rcrJUp c f1��
Tax map and parcel: Zoning:
Contact Person (Who should we call/write
concerning this project?): M
Address rX � l� f IT�r i1 rL Eb-fe City �e_SGo f Cr State VAI Zip z 2 ��-(
3(y 2 - y Z2 � Fax # E-mail m r lU a. t' -a Vl 0 Ct"D V -Y7 C-�� r3 of
Daytime Phone (_�
Owner of RecordGi i' �V f n --
Address c24 tiV 1' 1:H iyt_ Cl (ase-- City �RS(/i l I C -k State A Zip 2 2q,4
11
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
L1�'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
[/EXTERIOR
ection 5.2 (b) 1)]
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)]
L11SALES
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 Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
7/1/2011 Page 1 of 2
M TRAFFIC
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)]
EJXf'ARKING
All vehicles used in a home occupation and all vehicles of customers, clients or students shall be parked on-site.
[Section 5.2 (f)]
® ERFORMANCE STANDARDS
The home occupation shall comply with the performance standards in section 4.14. [Section 5.2A (1c)]
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).
D4R"OHIBITED 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 Horne 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 owner/Applicant Date111#144 (
�-
Print N' e Daytime phone number of Signatory
a aid �5
Rev' wer Date
ENGINEER'S REPORT ATTACHED: YES NO__V/
CONDITIONS:
A
7/1/2011 Page2of2
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
1 certify that notice of the application;
[County application name and number]
was provided to the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number by delivering a copy of the application in the
manner identified below:
and delivering a copy of the application to
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify the recipient of the record and the recipient's
title or office for that entity]
on �/�J����
Date
Mailing a copy of the application to
[Name of the record owner if the record owner is a person;
if the owner of record is an entity, identify the recipient of the record and the recipient's title or
office for that entity]
on
Date
to the following address:
[address; written notice mailed to the owner at the last known address of the owner as snown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Signature of pplicant
�/ l
Print Applicant Name
Date .J