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Initial Application Date: U3 10
-j 8~n_ App
lication # 10 S~DATE CU
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Liilington, NC 27546 Phone: (910) 893-7525 Fax: (910) 893-2793 www.hamett.org/permits
LANDOWNER: J 014 W PVJLit, ~~nSfi-1 «f j , ~ Ll C • Mailing Address: ~ 7 C> P i" 54Ct~ Si'-
City: L), I V1 State: NG Zip: Z1S46 Home Contact C`) 10 814 "y Z3 So
APPLICANT'': Mailing Address:
City: State: Zip: Home Contact
'Please fill out applicant Information H different than landowner
CONTACT NAME APPLYING IN OFFICE: J asw ?h co Phone 0108,l(4-4z9(.
PROPERTY LOCATION: Subdivision w/phase or section: C r-o hrf u Sea SOvn s Lot U (o Lot Acreage: , y O
State Road 13 Z3 State Road Name: %0O►,10f0 Q5A 'Ta-Ai Map Book&Page: 2001 /
Parcel: 09 95(x1 0q- 000(, ("s PIN: qq "ISO7-01 15a1-C)OO
Zoning:~A - & 1 Flood Zone:_')( Watershed: ~j Deed Book&Page: 211 9 / 82 PE Premise
,y« OW L r-r.. (PUh~LLL5
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: (0 1A
lnlfs YVt~1. r13 l U1ti~v Cam] i L'~ ) -~G1r i I C ~t~[t ri 1.
PROPOSED USE: 'Homes with Progress Energy as service provider need to supply premise number from Progress Energy Circle:
t ; SFD (Size 'fk x "J # Bedrooms_ # Baths Z • S Basement (w/wo bath) NIP- Garage 110 . Deck 1"rA • Crawl Space ab
(Is the bonus room finished? w/ a closet if so add in with # bedrooms)
❑ Mod (Size x_J # 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_J # Bedrooms Garage (site built?_) Deck (site built?_)
❑ Duplex (Size x_) No. Buildings No. Bedrooms/Unit
O Home Occupation # Rooms Use Hours of Operation: #Employees
❑ Addition/Accessory/Other (Size-x---_J Use Closets in add'ition(_„)yes (__)no
Water Supply: (County U New Well (J Existing Well (No. dwellings MUST have operable water before final
Sewage Supply: L-Kew Septic Tank (Complete New Tank Chackllso U Existing Septic Tank (J 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? (JYES I 'NO
Structures (existing or proposed): Single family dwellings
Required Residential Property Line Setbacks:
Front Minimum 3 S Actuai P 0
Rear ZS -73.15-
Closest Side 10 Z-]
Sidestreet/comer lot
Manufactured Homes Other (specify)
Nearest Building
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.
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Signature of Owner or Owner's Age Date
a fmm fha initial data If no oermita have been Issued"
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JASON PRICE
CONSTRUCTION INC.
Scale 1 40'
"THE- CARSON"
LOT 66 CAROLINA SEASONS
NAME: JU.50-i Pyira CbnS cCfisi, )nc • APPLICATION#: 10-500-2393
*This application to be filled out when applying for a septic system inspection.*
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)
910-893-7525 option I CONFIRMATION #
Environmental Health New Septic System Code 800
• Place "pink property flags" on each corner iron of lot. All property lines must be clearly flagged approximately
every 50 feet between corners.
• Place "orange house corner flags" at each corner of the proposed structure. Also flag driveways, garages, decks,
out buildings, swimming pools,_etc. Place flags per site plan developed at/for Central Permitting.
• Place orange Environmental Health card in location that is easily viewed from road to assist in locating property.
• 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. Do not grade property.
• Call No Cuts to locate utility lines prior to scheduling inspection. 800-632-4949 (This is a free service)
• After preparing proposed site call the voice permitting system at 910-893-7525 option 1 to schedule and use code
800 (after selecting notification permit if multiple permits exist) for Environmental Health inspection. Please note
confirmation number alven at end of recordina for proof of request.
• Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
o Environmental Health Existing Tank Inspections Code 800
• Follow above instructions for placing flags and card 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 option 1 & select notification permit if
multiple permits, then use code 800 for Environmental Health inspection. Please note confirmation number
alven at end of recording for broof of request.
• Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting for remaining permits.
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 Conventional Any
Alternative Other
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
NO
Does the site contain any Jurisdictional Wetlands?
{_}YES
( -J NO
Do you plan to have an irrigation system now or in the future?
{_}YES
{ -J NO
Does or will the building contain any drains? Please explain.
I_) YES
L_ej'NO
Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
{_}YES
( --rNO
Is any wastewater going to be generated on the site other than domestic sewage?
{_}YES
{ENO
Is the site subject to approval by any other Public Agency?
YES
( --f NO
Are there any easements or Right of Ways on this property?
{_}YES
{ --l"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 Maldng
The SitF Accessible So That A Complete Site Evaluation Can Be Performed.
`Rb 6pERTY.OWNERS OR O,"ERS LEGAL-REPRESENTATIVE SIGNATURE (REQUIRED)
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