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ENVH REFUND FOR SOIL EVAL�; 1 NORTH C "R©LI IA Account Number: Project Number: Vendor Name: Vendor Number: Remittance Address: Date 4 -02 -14 110 - 0000 - 345.18 -00 Walter L. Ray P O Box 35394 Fayetteville, NC 28303 . 0 .. ❑X Mail to payee Check to be picked up by: (Requires approval of Finance Officer) Approved: Disapproved: Reason for check request: Customer applied for a soil evaluation initially and then called to advise ENVH that there was an existing tank on the property that he hoped he could use. No soil work was completed and the existing tank was useable and a permit was issued for it. Amount of soil evaluation fee $750.00 - Existing tank Fee $100.00. Refunding the difference ($650.00). This check request has been examined by me and is hereby approved for payment. Department Head or uthorized Designee Date Graham H. Byrd, R.E.H.S. ThiMstrdnent has been preaudited in the manner required by the Local Government Budget and Fiscal Control Act Harnett County Finance Director Description Amount Partial Soil Evaluation Fee $ 650.00 Application # 14 -5 -33160 Applicant /Landowner : Walter L. Ray Location: 8543 NC 27 W Total Amount Due $ 650.00 Reason for check request: Customer applied for a soil evaluation initially and then called to advise ENVH that there was an existing tank on the property that he hoped he could use. No soil work was completed and the existing tank was useable and a permit was issued for it. Amount of soil evaluation fee $750.00 - Existing tank Fee $100.00. Refunding the difference ($650.00). This check request has been examined by me and is hereby approved for payment. Department Head or uthorized Designee Date Graham H. Byrd, R.E.H.S. ThiMstrdnent has been preaudited in the manner required by the Local Government Budget and Fiscal Control Act Harnett County Finance Director HTE #: 14 -5 -33160 HARNETT COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH 307 CORNELIUS HARNETT BOULEVARD LILLINGTON, NC 27546 EXISTING SEPTIC SYSTEM INSPECTION Name: Walter Ray Phone #: 476 -6447 Address: PO Box 35394 Name of Mobile Home Park or S /D: Name of Owner (if different): Address of Owner (if different): V5*3 Property Location (State Road name and #): �9541 NC27W Purpose of Inspection: Man. Home Placement (28'x70') The aforementioned site has been evaluated by the Harnett County Health Department Environmental Health Section. At the time of inspection, there appeared to be a septic system serving this site. If the system should malfunction, the owner is responsible for any necessary repairs. THIS INSPECTION IS VOID IF: 1. the intended use of the septic system should change, and /or 2. the system should fail or malfunction, and /or 3. the owner or tenant of the property change, and /or 4. after six months AUTHORIZATION OF EXISTING SYSTEM Signature of Environmental Hea pecialist 1 D Al Application Date: i5--)_� f �� Application # CU# COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION Central Permitting 108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 ext:2 Fax: (910) 893 -2793 www.h, ..A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) & SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE Al LANDOWNER:—W Q 14,o! L. _ Mailing Address: City: Fu / E ��G / %e State; Ne Zip 213a contact No: Email: APPLICANT*: j& l4:e r L. 'Rq 4 Mailing Address: JP. 0 y 3 S Ci T City: �t�P L/i J if State: ZIP:��Q,? Contact No: (® Email: *Please fill o applicant Information If different than landowner LP r t f / -7 7971 CONTACT NAME APPLYING IN OFFICE: Phone PROPERTY LOCATION: Subdivision: State Road # �cr i ^-� State Road Name: 6 Parcel: �z b J� / (�,�. PIN: Zoninggft-&�� Flood Zone:_ Watershed: Deed Book & f Lot #: Map Book & j *7q ^ 13ys Power Company *: *New structures with Progress Energy as service provider need to supply premise number from Progress Ern PROPOSED USE: 13 * ❑ SFD: (Size x�} # Bedrooms:_ # ths:_ Basement(w /wo bath):_ Garage:_ Deck:_ Crawl Space:,_,_ Slab: (Is the bonus room finished? (_) yes (_) no w/ a closet? (_) yes (_) no (if yes add in witl' Dedrooms) ❑ Mod: Size x ' ( _) #Bedrooms #Baths_ Basement (w /wo bath)_ Garage:_ Site Built Deck:` )n Frame_ O � Frame 1 (Is the second floor finished? (_) yes (_) no Any other site built additions? (M) yes o W Manufactured Home: _SW ✓bW _TW (Sfz�x j ) # Bedroorrtc Garage:_(site .ilt?_ ack:_(site built ?w� ❑ Duplex: (Size _x ) No. Buildings: No. Bedrooms Per Unit: ❑ Home Occupation: # Rooms: Use: Hours of Operation: ❑ Addition /Accessory/Other: (Size x_) Use: Closets in addition? (_) yes no Water Supply: ounlyt ^, Existing Well New Well (# of dwellings using well—) *Must have operable water before final Sewage Supply:_ T/ New Septic Tank (Complete Checklist) Existing Septic Tank (Complete Checklist) County Sewer Does owner of this tract of land, own land that contains a manufactured home within five hundred feet (500') of tract listed above?(_) yes (,_) no Does the property contain any easements whether underground or overhead (_j yes (_) no Structures (existing 1proposed engle family dwellings: Manufactured Homes: 1 t Oher (specify): tT,44 � , Required Residential Property Line Setbacks: Comments; 7 Front Minimum Actual �, / �Rear Closest Side j Sidestreet/comer lot Nearest Building on same lot Residential Land Use Application Page 1 of 2 APPLICATION CONTINUES ON BACK i i I 1- -A N N O D ;t7 z m C) O C z n m z :CJ O z 2 m D r 2 D n x z O m m a —1 w w ws; . W w w w W w 0 a 3 ; !� ; W D r w (P W cn w w A A (00 0 W O 0 N �J N 0 z 0 C n _ cn m cn _ Z Z D Z Z x --I Z m cn O r r z m z r r- —I D m co x' D m m m m x Z n r K m o z X r- _ o o� G) - z z x °� x x 0 0 z a D cn z cn C cn � T zz m 0 z 0 n z � m z D r m m m m m m m m= D WWwWWWwWWwWwwW�� �-������M��MQ0�n= N N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 0 N 0 N 0 N 0 N 0 N 0 m Qp P a -P, a41 -p .A .A a= cn ffl ffl fA ffl fA ff3 ff3 ffl ffl fA ffl ffl IS ffl z --I P. m Ot�i� o o o o C 0 0 cn 0' 0 cJii 0 cVn 0 0 cn 0 0 0 0 0 0 0 0 0 0 0 0 0 z C 0 0 0 0 0 0 0 0 0 IQ�� m N) m K5 v x x N N N N N N N N N N N N N N O O O O O O O O O O O O O O v A A A A A A A A A A A A A A D ^ m N m Z m U 0 c -Di m D r A r m m X --I D z Z D ;t7 z m C) O C z n m z :CJ O z 2 m D r 2 D n x z O m m BP821U01 Harnett County 4/02/14 Application Fees Maintenance 08:33:23 Application number . : Address . . . . . . : Position to . . . . . 14 50033160 8543 NC 27 W Type options, press Enter. 1= Select Amount Opt To Apply 3.00 100.00 _ 40.00 _ 25.00 _ .00 .00 13 Starting characters Previously Description Applied MAIL -IN PROCESSING FEE .00 PZ FLOOD PERMIT .00 PZ* SITE PLAN REVISION .00 REVIEW RESIDENTIAL PLANS .00 SOIL EVAL/NEW SEPTIC TANK; 750.00 911 REFLECTIVE SIGNS .00 F3 =Exit F9= Display all F12 =Cancel Paid Inactive .00 .00 .00 .00 750.00 .00 Bottom