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LAND USE(i - ) /5j, Initial Application Date: ,c ` "L-- Application # Vi t f COUNTY OF HARNETT LAND USE APPLICATION Central Permitting 102 E. Front Street, Lillington, NC 27546 Phone: (910) 8934759 Fax: (910) 893-2793 LANDO ER: Nbt A . C. A430ea State: City: APPLICANT: t/A L A300 OME S City: S f% r) 6 R State: N C_ Parcel: ---A Zoning: 14 Flood Plain: Mailing Address: / Zip: A'73 O ~d.;L 1~ E-S ~ DvCR Phone Mailing Address: 3ao9 S, NORNER- POW- zip: °27330 Phone#: 9119-774/- 4Sa j PROPOSED USE: Sg. Family Dwelling (Size x_-) # of Bedrooms # Baths Basement (w/wo bath) Garage Deck ❑ Multi-Family Dwelling No. Units No. Bedrooms/Unit Manufactured Home (Size _S x25(o) # of Bedrooms 3 Garage N Deck Comments: ❑ Number of persons per household ❑ Business Sq. Ft. Retail Space Type ❑ Industry Sq. Ft. Type ❑ Home Occupation (Size x__) # Rooms Use ❑ Accessory Building (Size x__) Use ❑ Addition to Existing Building (Size x_) Use ❑ Other Water Supply: ounty (j Well (No. dwellings ) Other Sewage Supply: 711 ew Septic Tank Existing Septic T L) County Sewer U Other Erosion & Sedimentation Control Plan Required? YES NO J / / Structures on this tract of land: Single family dwellings Manufactured homes r ~Stka Property owner of this tract of land own land that contains a manufactured home Win fv ndr ~ c listed above? YES O Required Property Line Setbacks: Minimum ~ Actual Minimum / Actual / Front Rear f Side_ Corner Nearest Building If permits are granted I agree to conform to all ordinances and the laws of the State of North Carolina regulating such work and the specifications or plans submitted. I hereby swear that the foregoing statements are accurate and correct to the best of my knowledge. Q-n4l~ /o-a9 0,;l-- Signature of Owner or Owner's Ag nt Date "This application expires 6 months from the date issued if no permits have been issued" A RECORDED SURVEY PLAT AND RECORDED DEED ARE REQUIRED WHEN APPLYING FOR A LAND USE PERMIT If located with a Watershed indicate the % of Imperious Surface: DIRECTIONS-TO THE PROPERTY FROM LILLINGTON: U~ O O 0 5 a F~ r SITE PLAN APPROVAL J~Vi~l~ ~7 . DISTRICT USE #BEDROOMS Date U e 6. c~ Rewired P Mr.lrtW Lirlw S socks Front Actual i Side Comer L_~) Rear F= T Nearest Building re ~ ~ Z i >`n M e.rr tit - 7S a n i p e I ~r 0 UU~5b0©oi~~ I~ETT COUNTY HEALTH DEPARTMENT N017043 OVEMENT PERMIT 00-0115-70 Be it ordainAbye ar nett oard of Health as follows: Section III, Item B. "No Person shall begin construc- tion of any building at which a septic tank system is to be used for disposal of sewage without first obtaining a written permit from the Harnett Cou Health Department." Name: (owner) ~ New Installation Septic Tank Property Location: SR# - J' ❑ Repairs -(Nitrification Line Subdivision Lot # Tax ID # Quadrant # Number of Bedrooms Proposed: Lot Size: 1-1 t15- 6`" / Basement with Plumbing: ❑ Garage: -17(' t r~z~ ~ccl Water Supply: ❑ Well A' Public ❑ Community, -5-C) ft. Distance From Well: Following is the minimum specifications for sewage disposal system on above captioned property. Subject to final approval. Type of system: ❑ Conventional Other mil! X' /t7 C,6 n(/~ 7 r Una /Cm Size of tank: Septic Tank: gallons Pump Tank: gallons Subsurface No. of exact length width of depth of Drainage Field ditches of each ditch ~a ft. ditches ft. ditches in. French Drain Required: Linear feet Date: _ 0 This permit is subject to revocation if site Signed: S plans or intended use change. Environmental Health Specialist la~~ 07F /oeDf- 0.~ct iN QroQL.-~, Nay y - ~C~~MC 2© K D Ct J ~A 2.. 0 2001 1q 1^1,) 3Q o- ~1~L~ 0 c1 s, -I-~ s a _0 L'A 0 HARNETT COUNTY HEALTH DEPARTMENT AUTHORIZATION TO CONSTRUCT Authorization is hereby given to construct a wastewater sy 71-( the specifications described by Harnett County Health Department Improvement Permit # t7 3 .'This authorization shall be valid for a period not to exceed five (5) years from the date of issuance. This authorization will be invalid if ownership, site plans, or intended use change. Owner or Authorized Agent An in R Telephone # y~ Name: Address: Property Location: SR # IA 0 ( Road Name New Installation_ Repair Septic Tank Nitrification Lines X_ Subdivision Lot # Number of Bedrooms Proposed: 31 I X-7`D} Lot size: Basement With Plumbing Without Plumbing Water Supply: Well Public Minimum Well Setback: ft. Type of System: Conventional Other X Tank Volume: Septic Tank J gallons Pomp Chamber gallons ~v Number of fields Number of Lines per Field _ Length of lines j Width of ditches ft. Depth of ditches French Drain: Linear feet required No wastewater system shall be covered or placed into us by 6yyperson until an ins ection by the etermined tha SW= according to Harnett County Health Department has dete'rmined' the conditions of the improvement permit and that a valid operations permit has been issued Authorized or Harnett County Health Department J Date: Name: (Revised 21)CNSTRCT.WPD