LAND USEInitial Application Date: Application # 6( yc t W
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting 102 E. Front Street, Lillington, NC 27546 Phone: (910) 893-4759 Fax: (910) 893-2793
LANDOWNER: 1' 4 { r v t +L..( Mailing Address:
City: State. _ Zip: Phone
APPLICANT: r Mailing Address:
City: Pl.f C.4 1) t 3 7 C - State: t Zip: ~ 4 r Phone
PROPERTY LOCATION:` SR SR Name: = j 1,IPc Ed
Address: ~ t I
Parcel: _ 0 COO PIN: 046
Zoning: Subdivision: a
J
Lot ~ Lot Size: 0 g, 5S s
S
Flood Plain: Panel:
Watershed:
Deed Book/Page:
Plat Book/Page: X60
DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
D A fV -in !
- a t r t -,1?,, rill 1414
ve~'t
L r-4 - rT0 + << t r i<?~.
52 j41$ tvc-Y- L e 4
+ - rr
o ~e r,l.c.
~!anter,?,
r,.r: L',t , In Sr, A D S Q
11L 1 d /s I
04 nom.. , n(r n~
4F' '}C
{ =
PROPOSED USE:
Sg. Family Dwelling (Size~x~ # of Bedrooms # Baths
O Multi-Family Dwelling No. Units No. Bedrooms/Unit-
0
Manufactured Home (Size x_) # of Bedrooms
Number of persons per household
Business
❑ Industry
O Church
Sq. Ft. Retail Space
Sq. Ft.
Seating Capacity _
Kitchen
Basement (w/wo bath) Garage / Deck Q "j r
Garage Deck
rri
❑ Home Occupation (Size x# Rooms
Additional Information:
O Accessory Building (Size xUse
❑ Addition to Existing Building (Size x_) Use
❑ Other
Type
Type
Use
Additional Information:
Water Supply: (County (_j Well (No. dwellings Other
Sewage Supply: (New Septic Tank Existing Septic Tank ij County Sewer Other
Erosion & Sedimentation Control Plan Required? YES NO
Property owner of this tract of land own land that contains a,,,,ma,,,~~~nufactured home Win five hundred feet (500') of tract listed above? YES
Structures on this tract of land: Single family dwellings hoWAanufactured homes Other (specify)
Required Residential Property Line Setbacks: ~I7 Minimum Actual
Front 35 4t-,/
Rear 25~ . !
Side 10 J
C /r Corner 20
Nearest Building 10 J~
If permits aranted I agree to conform to all ordinances and the laws of the State of North Carolina regulating such work and the specifications or
planza464 hereby swear that the foregoing statements are accurate and correct to the best of my knowledge.
-/3-a6
Signature of Owner or Owner's Agent Date
"This application expires 6 months from the initial date if no permits have been issued"
A RECORDED SURVEY PLAT AND RECORDED DEED ARE REQUIRED WHEN APPLYING FOR A LAND USE APPLICATION
06/04
fv0 11
OWNER NAME: 00 l c Jl/lXX az)(fr APPLICATION JD(J l ~l.e V
*This application to be filled out only when applying for a new septic system.*
County Health Department Application for Improvement Permit and/or Authorization to Construct
IF THE INFORMATION IN THIS APPLICATION IS FALSIFIED, CHANGED, OR THE SITE IS ALTERED, THEN THE
IMPROVEMENT PERMIT OR AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. The permit is valid for either
60 months or without expiration depending upon documentation submitted. (complete site plan = 60 months; complete plat = without
expiration)
DEVELOPMENT INFORMATION
V New single family residence
❑ Expansion of existing system
❑ Repair to malfunctioning sewage disposal system
❑ Non-residential type of structure
WATER SUPPLY
❑
New well
❑
Existing well
V
Community well
❑
Public water
❑
Spring
Are there any existing wells, springs, or existing waterlines on this property? yes } no unknown
SEPTIC
If applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference, must choose one.
Accepted
Alternative
{ t/} Conventional
Innovative
} Other
Any
The applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in
question. If the answer is "yes", applicant must attach supporting documentation.
{_}YES
{1~4} NO
Does The Site Contain Any Jurisdictional Wetlands?
{_}YES
{ NO
Does The Site Contain Any Existing Wastewater Systems?
{_}YES
{ NO
Is Any Wastewater Going To Be Generated On The Site Other Than Domestic Sewage?
{_}YES
NO 4,
Is The Site Subject To Approval By Any Other Public Agency?
{_}YES
NO
Are There Any Easements Or Right Of Ways On This Property?
I Have Read This Application And Certify That The Information Provided Herein Is True, Complete And Correct.
Authorized County And State Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine
Compliance With Applicable Laws And Rules. I Understand That I Am Solely Responsible For The Proper Identification
And Labeling Of All Property Lines And Corners And Making The Site Accessible So That A Complete Site Evaluation Can
Be Performed. ,
LEGAL REPRESENTATIVE SIGNATURE (REQUIRED)
V___ E_0~
DATE
of
2 BAY ST
Q 2 SITE
L` Z m
w ZNATCHEZ TRAC 0;
wwo
w ~<v 0
U 1~ v
VICINITY MAP (no scale)
EIP'
a1
2
Z
2
L
06-179s
SEARSJO\06\600
NOTES / LEGEND
AREA BY COORDINATES
M
THIS LOT IS LOCATED IN A FEMA MAPPED
FLOOD HAZARD AREA AS DETERMINED BY
o
FEMA. MAP # 3720060200J; ZONE AE;
N
EFF. DATE 10/3/06.
FEMA BASE FOOD ELEVATION - 145.7 FEET
Y
EIP - EXISTING IRON PIPE
m
R/W - RIGHT OF WAY
Q
SQ. FT. - SQUARE FEET
MB - MAP BOOK
N
PROPOSED PLAN FOR
JOE & BARE
LOT 12 CAPTAIN'S LAN[
BLOCK 3 - MAP # 201
PIN # 0613-42-5180
BUCKHORN TOWNSHIP -
NORTH CAROLINA - OC
SCALE : 1 ° = 40'
a
ELEVATION TOP
EIP OF IRON PIPE
145.0'
L 1 .J.J.J
TIE TO INTERSECTION
OF NATCHEZ TRACE &
BAY STREET
0 10 20 40
BENTON DEWAR & AS
PROFESSIONAL LAND
5920 HONEYCUTT ROI
HOLLY SPRINGS, NC S
(919)-552-9813
SITE PLAN APPROVA'
DISTRICT u D -E~ #BEDROOMS
.V
Date
1, BENTON W. DEWAR CERTIFY THAT THIS PL
MY SUPERVISION FROM AN ACTUAL SURVEY
SUPERVISION; THAT THE RATIO OF PRECISIO
THAT THE BOUNDARIES NOT SURVEYED ARE
PLOTTED jPjQM INFORMATION FOUND IN BO(
PAGE -4 WT ; THAT THIS PLAT DOES
FOR RECORDING IN THE REGI OF D ED
LICENCE NUMBER AND S TH
PROFESSIONAL LAND SURVEYOR L-3040
THIS PLAT IS OF A BOUNDARY SURVEY OF
PARCEL OF LAND THAT IS REGULATED BY A
MUNICIPALITY ORDINANCE THAT REGULATES F
U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency Management Agency Expires February 28, 2009
National Flood Insurance Program Important: Read the instructions on pages 1-8.
SECTION A - PROPERTY INFORMATION For Insurance Company Use:
Al. Building Owner's Name S6495 Policy Number
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number
L 13A STt2 g-
Code 2_2S 7/'
City LJP 7 - W 91A44 StateNOXI* 41=UA* ZIP
A3. vropeny uescnpuon (Lot ana rjiocK Numoers, i ax rarcei Number, Legal uescnption, etc.)
W1.7 T- 12 44pTa)N"S L.4111264 4 SL 04Y 3 MAp # Zoo
A4. Building Use (e.g., Residential bNon-Residential yAddition, Accessory, etc.) l% 1 p9m 114L-
A5. Latitude/Longitude: Lat. 35 2-R Z) S Long. n 57-- 055' Horizontal Datum: ❑ NAD 1927 NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number S_
A8. For a building with a crawl space or enclosure(s), provide: A9. For a building with an attached garage, provide:
a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage 019- sq ft
b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attact> arage
enclosure(s) walls within 1.0 foot above adjacent grade /A walls within 1.0 foot above adjacent grade FF~r~~
c) Total net area of flood openings in A8.b N/A- sq in c) Total net area of flood openings in A9.b ~ sq in
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Bl. NFIP Community Name & Community Number
44 Go 3 b 32`x3
B2. County Name
h~F_W eT(~
B3. State
#J o>!.v* ' :4V-bLJ ~
B4. Map/Panel Number
B5. Suffix
B6. FIRM Index
Dat
A
B7. FIRM Panel
Effective/Revised Date
OG-~-, -:5 2M04
B8. Flood
Zone(s)
A
B9 Base Flood Elevation(s) (Zone
AO, use base flood depth)
1+6.7
B10. Indicate the source of t e Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
❑ FIS Profile FIRM ❑ Community Determined ❑ Other (Describe)
B11. Indicate elevation datum used for BFE in Item 139: ❑ NGVD 1929 D<NAVD 1988 ❑ Other (Describe)
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes No
Designation Date W/4, ❑ CBRS ❑ OPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: onstruction Drawings` ❑ Building Under Construction' ❑ Finished Construction
•A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones Al-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-g
below according to the buildin diagram specified in Item A7.
Benchmark Utilized NG&kS Z• blzr,> Vertical Datum N4VD Z~
Conversion/Comments MOT : e VAJW,%7-'Mb
Check the measurement used.
a)
Top of bottom floor (including basement, crawl space, or enclosure floor)
SS .
_ Kfeet
❑ meters (Puerto Rico only)
b)
Top of the next higher floor
WA- .
❑ feet
❑ meters (Puerto Rico only)
c)
Bottom of the lowest horizontal structural member (V Zones only)
tJ/A- .
❑ feet
❑ meters (Puerto Rico only)
d)
Attached garage (top of slab)
N/A- .
feet
❑ meters (Puerto Rico only)
e)
Lowest elevation of machinery or equipment servicing the building
1 S S
feet
❑ meters (Puerto Rico only)
(Describe type of equipment in Comments)
f)
Lowest adjacent (finished) grade (LAG)
14 S
O ® feet
❑ meters (Puerto Rico only)
g)
Highest adjacent (finished) grade (HAG)
J 4S .
- feet
❑ meters (Puerto Rico only)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
information. I certify that the information on this Certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 US. Code, Section 1001. .J► CARn,
❑ Check here if comments are provided on back of form.
Certifiers Name 6el'a , m . ~1:V License Number 1'LS . J
J
Title ~llll Company Name DENTZ>Aj
1+W
Address City State ZIP Code
S~Zv -1-~t Lu rr =D 4-)D" SpwA.1145. 2546
919.552-9813
FEMA Form 81-31, February 2006
See reverse side for continuation.
Replaces all previous editions
IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use:
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number
Lic)o eA S C~
cityrtj&) 1 „P 44 State gpvtT,} eArvU Aj4 ZIP Code Company NAIC Number
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments
❑ Check here if attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without BFE), complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,
and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade (HAG) and the lowest adjacent grade (LAG).
a) Top of bottom floor (including basement, crawl space, or enclosure) is _ ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawl space, or enclosure) is ^ ❑ feet ❑ meters ❑ above or below the LAG.
E2. For Building Diagrams 6-8 with permanent flood openings provided in SectigtLA Items 8 and/or 9 (see page 8 of Instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is _ ❑ feet I_..J meters ❑ above or below the HAG.
E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is _ Q feet meters ❑ above or ❑ below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑ Yes ❑ No ❑ unknown. The local official must certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or community-issued BFE)
or Zone AO must sign here. The statements in Sections A, 8, and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑ Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E),
and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8. and G9.
G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who
is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AO.
G3. ❑ The following information (Items G4.-G9.) is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued
G7. This permit has been issued for: ❑ New Construction Substantial Improvement
G8. Elevation of as-built lowest floor (including basement) of the building: ❑ feet ❑ meters (PR) Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments
❑ Check here if attachments
FEMA Form 81-31, February 2006 Replaces all previous editions
~COUNTY TAX 0#
FOR NJ 3sTAgY O~y AWN OF DEEM
WHY 0412:24:9 F1
BK:2222 P6:199.301 FlF:sM*
WC Kv I1~TM 11
CAROLINA GENERAL WARRANTY DEED
Mail/Box to: EjjzabEth
This instrument was prg
Brief description for the
THIS DEED made this
MARY MCFARLAND MASSEY
L. MASSEY
100 Say
County on tho day of .20
MICHAEL DUPREE AND BEVERLY DUPREE
100 Bay Sum
aquay-Varina, NC 27526
Enter in appropriate block for each party:
The designation Grantor and Grantee as used h u
singular, plural, masculine, feminine or neuter as
WITNESSETH, that the Grantor, for a valuable coi
andby these presents does grant, bargain, sell and c
in the city of Fuauay-Varina _ Townsbip, Harnett
BEING all of Lot 12 and Lot 13 Captain's Landing, ock:
Registry.
The property hercinabovc described was acquired by Grantor by
A map showing the above described property is recorded in W
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and
in fee simple.
their heirs, successors, and assigns, and shall include
w,diereceipt ofwhichishereby acknowledged has
simple, all that certain lot or parcel of land situated
more particularly described as follows:
In Map Book 2006, Page 369, Harnett County
in Book 2161, page 160.
thereto belonging to the Grantee
NC Bar Association Form No. 3 0 1976, Revised 0 1977, 2002
Printed by Agreement with the NC Bar Association -1981 - Chicago Title
Application Number: 61.E ✓(/0/J 76(
Harnett County Central Permitting Department
PO Box 65, Liilington, NC 27546
910-893-7525
Environmental Health New Se S ste s Test
Environmental Health Code 800
• Place "property flags" on each mer iron of lot. All property lines must be clearly flagged approximately every 50 feet
between comers.
• Place "house comer flags" at each comer of where the housetmanufactured home will sit. Use additional flagging to
outline driveways, garages, decks, out buildings, swimming pools, etc.
• Place flags at locations as developed on site plan by Customer Service Technician and you.
• Place Environmental Health "orange" card in location that is easily viewed from road.
• If property is thickly wooded, Environmental Health requires that you clean out the undergrowth to allow the soil
evaluation to be performed. Inspectors should be able to walk freely around site. No grading of property should be
done.
• After preparing proposed site call the voice permitting system at 910-893-7525 and give code 800 for Environmental
Health confirmation. Please note confirmation number alven at end of recording for proof of request.
• Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting for permits.
❑ Environmental Health ExIstina Tank Inspections
Environmental Health Code 800
• Place Environmental Health "orange" card in location that is easily viewed from road. Follow above instructions for
placing flags on property.
• Prepare for inspection by removing soil over door as diagram indicates. Loosen trap door cover. (Unless inspection is
for a septic tank in a mobile home park)
• After preparing trapdoor call the voice permitting system at 910-893-7525 and give code 800 for Environmental Health
confirmation. Please note confirmation number alven at end of recordina for proof of request.
• Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting for remaining permits.
❑ Health and Sanitation Inspections
• After submitting plans for food and lodging to Central Permitting, please allow approximately 7-10 working days for plan
status. Use Click2Gov or IVR to hear results.
• Once all plans are approved, proceed to Central Permitting for remaining permits.
❑ Fire Marshai Inspections
• After submitting plans for Fire Marshal review to Central Permitting, please allow approximately 7-10 working days for
approval. Use Click2Gov or IVR to hear results. Once all plans are approved, proceed to Central Permitting for permits.
• Fire Marshal's letter must be placed on job site until work is completed.
Public Utilities
• Place stake with "orange" tape/name thirty feet (30) from the center of the road at the location you wish to have water
tap installed.
• Allow four to six weeks after application for water/sewer taps. Call Utilities at 893-7575 for technical assistance.
Buildina Inspections
• After submitting plans for Building Inspections, please allow approximately 3 working days for review. Use Click2Gov or
IVR to hear results. Once _l plans are approved, proceed to Central Permitting for permits.
• For new housing/set up permits must meet E 911 /Addressing guidelines rior to scheduling final inspection.
• Use Click2Gov or IVR to hear results.
E911 Addressina
Addressing Confirmation Code 814
• Address numbers shall be mounted on the house, 3 inches high (5" for commercial).
• Numbers must be a contrasting color from house, must be clearly visible night and day at entrance of driveway if home
is 100 ft or more from road, or if mailbox is on opposite side of road.
• Once you purchase permits and footing inspection has been approved call the voice permitting system at 910-893-7525
and give code 814 for address confirmation. This must be called in even if you have contacted E911 for verbal
confirmation.
• Inspection results can be viewed online at htto.lAvww.hamett.ora/services-213.aso then select Click2Gov
Applicant/Owner Signature ~r~~ Date