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Initial Application Date: L 1 - 4 19 7) Application # / �3-° g 2
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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.hamettorg/permits
LANDOWNER: l t9 1 ri 1
g'�l 0- 111 ✓
1 0 ri Mailing Address: qf c,) ` kf,ttt9 relict) £d'
City: ions A l{J-�`(�'�U.l,_I t(C -l7-C Slate: N l /. . Zipyx Home #Q ?4 - 70-A371 ?4""
city: tiea.>w0
APPLIC y
�1 Mailing Address: t Q 3 DAL O !,
cit IJ I0 fa rt LAD 4r( State:/v C Zip: Or7 S Home #:Q19 an ,35 Contact #: C if 9 - ¥O G9
* Please 1111 out applicant Information If different Than I.. 'owner
CONTACT NAME APPLYING IN OFFICE: N- - _ as • ! I t-L- Phone #: gig - 19 fr _54v a /
PROPERTY LOCATION: Subdivision w /phase or section: n A nt 7 n A Lot #: 9 Lot Acreage: d 110 9
State Road #: 1a n 7 t State Road Name:
U e: 615-Lit i3IAG -A,Q //1 �J kl 7�J Map Bookk &Page: at fl -7 58 4
Parcel: i 3 94 C i �1 > 2 2 /1 PIN: r / — "7 1 �Sr
— /,s p( 57 O
Zoning: 43 n Flood Zone: nCl Watershed: N A - Deed Book &Page: (')J 3 Q Da Power Company': C(Al 0
New homes with Progress Energy as service provider need to supply premise number II / n� from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: U / N @
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OSED USE:
y qq Circle:
SFD (Size J x ,�7) #Bedrooms # Baths Basement (w/wo bath) Garagelry� Deck Crawl Space / VI
(Is the bonus room finished? w/ a closet it 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 ) # Bedrooms Garage (site built? ) Deck (site built? 1
❑ Duplex (Size x ) No. Buildings No. BedroomslUntt
❑ Horne Occupation # Rooms Use Hours of Operation: #Employees
❑ Addition/Accessory/Other (Size x ) Use Closets In addition( _yes (_)no
Water Supply: g Cqunty L j Well (No. dwellings 1 MUST have operable water before final
Sewage Supply: ( ew Septic Tank (Complete Checklist) (J Existing Septic Tank (Complete Checklist) ( )Cou ewer
Property owner of this tract of land own land that contains a nufactured home w /in five hundred feel (500') of tract listed above? (___)YES bg
Structures (existing & proposed): Stick Built/Modular Manufactured Homes Other (specify)
Required ResldenhtaI Property Line Setbacks: Comments:
Front Minimum 35 Actual 130
04.J
Rear 91 •1%
Closest Side I 0 & 0
SidesireeVcornertot a 0
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 fore.oing 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 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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• NAME I.) a) I (4 1 as./ I o / APPLICATION #: /F 5—‘2v Z4fl
"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 1 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.
• Gall No Cuts to locate utility lines orior 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 recording for proof of request,
• Use CIIck2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
❑ Environmental Health Existing Tank Insoectiona 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
ohm at end of recordina 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 desjred system type(s): can be ranked in order of preference, must choose one.
(_) Accepted f_J Innovative f_J Conventional (_) Any
l_J Alternative I_) 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 f NO Does the site contain any Jurisdictional Wetlands?
(_ }YES 1W4 NO Do you plan to have an irrigation mist= now or in the future?
(_)YES ( Imo NO Does or will the building contain any claim? Please explain.
I_) YES ( NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
(_}YES f NO 1s 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 NO 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.
1 Have Read This Application And Certify That The Information Provided Herein Is True, Complete And Correct, Authorized County And
State Omctals 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 Acce o That Comp to Site Evaluation Can Be Performed.
ID - y/0
PROPER WNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
5/08
How to Properly Mark Property for Soil Evaluation
(MUST MATCH SITE PLAN)
'ink flag
n o iron
pink flag —+, orange flag
1 , ~ ink flag
Legend House
iron
flag
Lange flag
pink flag
iron ® co iron
ROAD