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Application for ,
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Class A Home Occupation Clearance N'
Home Occupation Class A Clearance = $25.00
❑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: V I
Tax map and parcel: Zoning:
Contact Person (Who should we call/write concerning this project?):
Address LA I f` __ City
Daytime Phone (� .� C �ax # (_)
Owner of Record
Address
State Zip
E-mail kbli%1 ��'1@tA60 (bC/�Q-'
Daytime Phone(0-5AS
'5'e ---Fax # {�}
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)]
AEXTERIOR 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) X)]
1114 SALES
No home occupation shall sell goods to a customer who comes to the site except for goods that are haled -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 of 2
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)]
PPARKING
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 proceduresq 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).
PROHIBITED 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. &_4,;L -k,-,
Sig ture of O ner/Applicant Date
qw- bed6-
Print Nam Da ity a phone nu ber of Signatory
lei oZ�
-Z
Reviewer Date
ENGINEER'S REPORT ATTACHED: YES NO
CONDITIONS:
7/1/2011 Page2of2