HomeMy WebLinkAboutHO201600173 Application 2016-06-03FOR OFFICE USE ONLY HO # C�7040- / 11,31
acs
Fee Amount $ Date Paid 4�-s By who? 4M rw— Receipt # 14'17/fo Ck# "7a1-3 By:
Application for
Class A Home Occupation Clearance'�r
ome Occupation Class A Clearance = $27.00
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:VA _.f.�Uv� If Z li`l Tax map and parcel: /y ° r)L3t�
—400 Zoning: '� !�
Contact Person (Who should we call/w„rittr cionccming this project?); /: Q c�
Address 11 [Y 1� t_ii r ;�\i'i� City l3 � esA { } u state zip Zs) 0
Daytime Phone(_"3�k
Owner of Record a Low
Address
Daytime Phone (___)
Fax # L_)
E-mail 3� 1 .�IC�V11 F ��3?CXM C�J . C OM
City e#AaoT -p5yd f state V.4 zip
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
GrLOCATION & 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)]
13-fXTERIOR 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)]
Lid' 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 Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
11/1r2015 Page 1 af2
(`TRAFFIC
The traffic generated by a home occupation shall not exceed the volume that would normally be expected by
dwelling unit in a residential neighborhood. [Section 5.2 (e)]
MI"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)]
O-FERFORMANCE 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?
NOISE
VIBRATION
GLARE
HEAT
AIR POLLUTION
WATER POLLUTION
RADIOACTIVITY
ELECTRICAL DISTURBANCE
NON -DOMESTIC WASTE DISCHARGED TO A SEPTIC FIELD OR SEWER
YES
NO
.�
✓
g0`
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 5.11
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 Horne Occupations, that I understand them, and that I will abide
by them.
C)en4e,�i'A)
Signatig of Ownerr/ licant
Pr' a e
ewer
ENGINEER'S REPORT ATTACHED: YES NO
CONDITIONS:
Date Ca I
L(3 (4 91& ! 8-43 5 6
Daytime phone number of Signatory
Date
11/1/2015 Page 2 of2
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.
I certify that notice of the application,
was provided to
[County application name and number]
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
the owner of record of Tax Map
by delivering a copy of the application in the
[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
Mailing a copy of the application to a HA,., Tel CAM
[Name of the record owner if th 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 to the following address:
Date
Cam'
[address; written notice maile the owner at the last known address of the owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
Sig6dure of AppUcant
Print Applicant Name
Date