LAND USE 0 / �
Initial Application Date: / -/0 Application # /0 '�� Z E�
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting
� -y� 108 E. Front t�reel NC 27546 p Phone: (910) 893 -7525 p Fax: (910) 893 -2793 www.hamett.org /permits
LANDOWNER: ✓1/Tu WR U I C.,(C ENZ Mailing Address: PO DX 1415
Cit Ckbfr& state:A/C Zip: Z760b Home #: q1014'.3 -F789 Contact #:7 637 - 6/0/ - 606
APPLICANT*: 6m/aFoRb Fil)Wk Mailing Address: .. Tt 910-8/9 9557
Cit 6u1E5 (PECK_ State^)L Zip: 27s Home #: 5711111- Contact #: 6401E
'Please fill out applicant information it different than landowner q1,, /I q p /
t CONTACT NAME APPLYING IN OFFICE: 13E J4)q 1 /V ZOR Phone #: 9/O -b (y 9 QQ -8197
PROPERTY LOCATION: Subdivision w /phase or /egc-
section: 1 p`]
( . - t 0 Lot #,;/ Lot Acreage: • 7 1
State Road #: 1521 State Road Name: l7 CoR CIRC I Map Book &Page: 5i6 /
Parcel: 110670 -03 b PIN: Pinta 06 76 - 66 -q262_000
Zoning: HA 30 Flood Zone: Watershed: r- Deed Book &Page: 639 / 1-T - PE Premise #: �7 �/
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: 42/ 5ou 771 ( y F 2 / / V 2 [ s
TO /U1/53 cep st79,t /C r, 7 f FFT ONTO /rmg /N sT-
,5 mitt" ro 3,1) 5772e[=T CAJ L9FT - C EC - -o,`1 C(/1CC/f -
luRM LEFT- /- mint; 770 Wit-ITr /f6Usc 04) 1.6 - /02
PROPOSED USE: 'Homes with Progress Energy as service provider need to supply premise number from Progress Energy Circle:
❑ SFD (Size x ) # Bedrooms_ # Baths_ Basement (w /wo bath) Garage Deck Crawl Space i Slab
(Is the bonus room finished? w/ a closet if so add in with # bedrooms)
❑ Mod (Size x ) 4 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 (Sizex ) # Bedrooms Garage (site built? ) Deck (site built? )
❑ Duplex (Size x ) No. Buildings No. Bedrooms /Unit
ome Occupation #Rooms
A< A Use / � _ Hours of Operation: #Employees
Clos ets Addition /Accessory/Other (Size 27 x 3 / � ) Use /T/�� rC � -.nave /�(y��'/jl ets in additionOyes (_)no
Water Supply: ( ) County ( I New Well 04 Well (No. dwellings ) MUST have operable water before final
Sewage Supply: (i New Septic Tank (Complete New Tank Checklist) (f/rExisting Septic Tank ( ) 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? (_)VES (r-)rv0
Structures (existing or proposed): Single family dwellings / Manufactured Homes Other (specify) 52
Required Residential Property Line Setbacks: Comments:
Front Minimum "3(-) Actual /
Rear 2r 38
Closest Side /0 20
Sidestreet/comer lot
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 forego' g statem s are accurate a correct to the best of my knowledge. Permit subject to revocation # false information is provided.
• , 6 — / - /O
SI ature Owner ar Owner's Agent Date
lll ��� "This application expires 6 months from the initial dale 11 no permits have been Issued"
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REOUIRED WHEN APPLYING FOR LAND USE APPLICATION
Please use Blue or Black Ink ONLY •
LAND USE 5/08
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NAME: APPLICATION #: Ii/ 9 " Z4
*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 mohs y without expiration
depending upon documentation submitted. (complete site plan = 60 months; complete plat = without expiration) 19, b4 '
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
kz confirmation number given at end of recording for proof of request.
Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
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
given at end of recording for proof 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?
( (_} NO Do you plan to have an i¢igalion system now or in the future?
(_)YES {_) NO Does or will the building contain any drains? Please explain.
( _ {YES I} NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
{_)YES (_) NO Is any wastewater going to be generated on the site other than domestic sewage?
(_)YES (_} 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 I_} 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 1 Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site • ' • • ble So That A C pi o '- 5i faluation Can Be Performed.
P' ii.' . ' - Oi ERS I ' OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
/ 5/08
DIAGRAM O A TYPI I AL SE' TIC TANK
UTLET LID
POSSIBLE POSSIBLE
HOUSE HOUSE
CONNECTION _ CONNECTION
POSSIBLE
HOUSE
CONNECTION
POSSIBLE LID SHAPES
I _ I SQUARE (SHOWN ON DIAGRAM)
RECTANGLE (OLDER TANKS) ROUND
How to Properly Mark Property for Soil Evaluation
(MUST MATCH SITE PLAN)
1
ink flag
1_
i '. ®
p iron
pink flag —+,, orange flag
1 i ink flag
Legend House
0 \ a
iron
fl Olt ,
range flag'
pink flag
iron G 0 iron
IS
ROAD