LAND USE 4 /� P
Initial Application Date: 4 /° Application # /" C ° 2 4 O fy�/
DRB # CU #
COMMERCIAL oZ n /
COUNTY OF HARNETT LAND USE APPLICATION ((//�(()) 6I/ GG i ( / l� /
Central Permitting 108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.hamett.org7 mit
LANDOWNER: frig j 1 i her/1(L�at 9�1 Mailing Address: P. 0. ono( t?
Cit 1-I lit , I1 I ipt7 '� '' State:At zip:2,1MM 54 Contact # a/n - 4 a LO Email:
APPLICANT': I ( r u '4t- P rn ` 2 1 p niP. �w� `7
Mailing Address: PO • 381 / 2-9 ?
C L) 1 r"] State:4 1t Zip: i154/, Contact# T'Q' /Q - l0ASb Email:
*Please fill out a nt information if different than landowner �I 1
CONTACT NAME APPLYING IN OFFICE: . 3 UAL )71, l i'vnp h 11 Phone # qm - Q78 ‘46 6» ')
PROPERTY LOCATION: Subdivision: Fit g4F7 SI)1/]4 r Lot # of / Size: 2. , ?eke
State Road # Ot / c 1. State Road Name: Map Book &Page: -6./ ' / _
Parcel: /,3D.s.Z M7' a PIN: 00P V • #3 /#. aoi
Zoning: RR-3 l) Flood Zone: / Watershed:SA Deed Book &Page: 0 1111 / 0737 Power Company': P!7(7(/ SS .t`.gey,
LJ 'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: lOA ,f3 7 Wes" Ap nu . /fll f. � '7 Mi /P.S .
e.11urnh wit/ he nn r (j/ beige /miff Yicfo� ln,herr it44.
PROPOSED USE:
❑ Multi - Family Dwelling No. Units: No. BedroomslUnit:
❑ Business Sq. Ft. Retail Space: Type: # Employees: Hours of Operation:
II Daycare # Preschoolers: # Afterschoolers: # Employees: A Hours of Operation: (oRM - (o?/V1
❑ Industry Sq. Ft: Type: # Employees: Hours of Operation:
❑ Church Seating Capacity: # Bathrooms: Kitchen:
❑ Accessory/Addition /Other (Size x ) Use:
Water Supply: ✓ County Existing Well New Welll (# of dwellings using well ) 'MUST have operable water before final
Sewage Supply: New Septic Tank (Complete Checklist) ✓ Existing Septic Tank (Complete Checklist) County Sewer
Comments:
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.
' X5ok i ,‘) Heil 06 - D7 -4DM
Signature of Own r or Owner's Agent Date
"'This application expires 6 months from the initial date if permits have not been Issued""
VAIRECORDED..URVEY MAP;IRECOROED DEEDw OROFFE...O.PURCHASE� AND_PLATjARE;REOUIRED Af±PLYING FOR,L "AND USE
Commercial Land Use Application Page 1 of 1 03/10
NAME: . a / Lai 1 I 1 APPLICATION #: /P CX 24 n
*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.
• 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 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 a 1 .lying for authorization to construct please indicate desired system type(s): can be ranked in order of preference, ust choose one.
( Accepted [ Innovative 1 ) Conventional (_) Any
(_ Alternative {_} Other
The .pplicant shall notify the local health de artment upon • bmittal of this application if any of the following ap to the property in
quest on. If the answer is "yes ", applicant • ust attach suppo 'ng documentation.
(_} ,ES 1—) NO Does the site c. tain any Jurisdictio .1 Wetlands?
(_} 15 (_)NO Do you plan to have an'I —t now or in the future?
[) . S (_I NO Does or will t e building contain any • _ ? Please explain.
1 —IY . (} NO Are there an existing wells, springs, wat: lines or Wastewater Systems on this prope y?
(_}YE' f NO Is any wast; ater going to be generated on e site other than domestic sewage?
{_ }YES [_) NO Is the site • bject to approval by any other Pu.lic Agency?
(_)YES (_) NO Are there •ny easements or Right of Ways on th property?
(_)YES } NO Does th• site contain any existing water, cable, ph, e or underground electric lines?
If yes lease call No Cuts at 800- 632 -4949 to locale 'e lines. This is a free service.
I Have Read Thi - • pplication An. Certify That The Information Provided Herein Is T e, Complete And Correct. • uthorized County And
State Officials Are ranted Rig Of Entry To Conduct Necessary Inspections To Determin- Compliance With A; I licable Laws And Rules.
1 Understand That I • m Solely ' esponsible For The Proper Identification And Labeling Of All P . w rty Lin nd Corners And Making
The Site Accessible So . • Complete Site Evaluation Can Be Performed.
ib OWNE e
PROP TY OWNERS OS LE
LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DA E
5/08