LAND USE
Initial I Application Date: J Application #
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108/E. Front Street, Lillington, NC 27546 Phone: (910) 893-7525 Fax: (910) 893-2793 www.harnett.org/permits
LANDOWNER: Mailing Address:
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City! GA`/~771 ItI State :A1C'. I 91U"`/i's6"e{/~f~~ Contact
APPLICANT': $4c !f Mailing Address: 514 i L~"f /r-8d y~
City: State: Zip: Home Contact
`Please fill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: Phone G112- n
PROPERTY LOCATION: Subdivision w/phase or section: A6&Y7 !ilk f f ~J' Lot ~ Lot Acreage: 6.3'71
State Road _ State Road Name: Map Book&Page: ~D67
Parcel: NcfG~3uo0 s 00-N' b-) PIN: OS/~o -Ao-.37-7
Zoning: 9A-209 Flodd Zone: X Watershed: A)/I~ Deed Book&Page: Q~57V / 0 VO Power Company': 5 /Z E
'New homes with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: //Uj)/ 0 -7 0) -7-0 yoxs£l~e 'f'a
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7 Circle:
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OFD USE: UDC
FD (Size toff x 5D) # Bedrooms, aL # Baths Basement (w/wo bath) A10 Garage l Beek 11 /CravA Space / Slab
(Is the bonus room finished?-- CS w/ a closets if so add in with # bedrooms)
❑ Mod (Size_x_ ) # Bedrooms- # Baths- Basement (w/wo bath) Garage Site Built Deck ON Frame / OFF
(Is the second floor finished? Any other site built additions? )
❑ Manufactured Home: SW DW TW (Size_x____) if Bedrooms _ Garage _(site built? Deck_(site built?--)
❑ (Duplex (Size_x) No. Buildings No. Bedrooms/Unit
❑ Home Occupation # Rooms Use Hours of Operation: #Employees
❑ Addition/Accessory/Other (Size_x) Use Closets in addil (ono
Water Supply: County L-) Well (No. dwellings MUST have operable water before final
Sewage Supply: New Septic Tank (Complete Checklist) Existing Septic Tank (Complete Cheekiisp (County Sewer
Property owner of this tract of land own land that contains a manufactured home w/in five hundred feet (500') of tract listed above? (-)YES ~10
Structures (existing & proposed): Stick Built/Modular Vanufactured Homes Other (specify)
Required Residential Property Line Setbacks: M~ s:
Front Minimum 35 Actual to
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Rear
Closest Side /0
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SidestreeUcorner lot ❑9 ~
Nearest Building -/V
on same lot
if permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
Sign liature 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 MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
Please use Blue or Black Ink ONLY
LAND USE 5/08
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LANDOWNER H&H Constructors, Inc.
2919 Breezewood Ave, Ste 400
Fayetteville, NC 28303
910-486-4864 APPLICATION Os
OWNER NAME: n
Q 13
*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 f f
ew single family residence v/'-e
❑ Expansion of existing system
❑ Repair to malfunctioning sewage disposal system
❑ Non-residential type of structure
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WATER SUPPLY
❑ New well
❑ Existing well
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i
c wOvat well
12blic water
❑ Spring
Are there any existing well prings, or existing waterlines on this property?
L} 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 Innovative
L_} Alternative {_J Other
Conventional {,A 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 {_}ENO 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?
ICI {VJYES NO Is the site subject to approval by any other Public Agency?
{_}YES {_}!NO Are there any easements or Right of Ways on this property?
{_}YES {yam} NO Does the site contain any existing water, cable, phone or underground electric lines?
If yes please call No Cuts at 800-632-4949 to locate the lines. This is a free service.
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.
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PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
11/06
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