LAND USE / 1 ,sir24Z2
Initial Application Date: ob /S! �/d Application #
DRB # CU #
COMMERCIAL -
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 27548 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.hamett.org /permits
LANDOWNER:33v &dr h /P ad g/ /1/ i C{t r0 ha- Mailing Address:
City: Ft 'ix - 1. / Statea)c. Zip Contact # Email:
APPLICANT* as' - ^. .4 : A, 12 Mailing Address: /S / S. /j+D,. SI •
. City:�4 /C , ✓4et14 Statiej L Zip: 77 sobonlact # Email:
'Please SM cis a pplicant information if different than landowner ��. //, p p 1 O ¥ (7 A
CONTACT NAME APPLYING IN OFFICE: C ZJCR A- ' 7 A (C Gantt. Phone # / // 3 7 S 7
PROPERTY LOCATION: Subdivisiow— f /l1 Lot #: /2'- Lot Size: /0 9
State Road J # /J 4 State Road Name: 7j� * ip/ b GT- (:lo/ j Map Book &Page: I` #/ C 1,5
Parcel: f/ j 9W/ ( /7- PIN: /o S 1171/y7 se— S6 -79 36 r Pad
Zoning: <✓
Flood Zone: X Watershed: � Deed Book &Pa a Power Company*:
New structures with Progress Energy as service provider need to supply premise LW/ / f /fr ro , .J Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: /1 " L9 Ill / x a Ant '1 .
PROPOSED USE:
❑ Multi- Family Dwelling No. Units: No.. edroor / 11: /
-r Business Sq. Ft. Retail Space: / 3 // Type: //a, `ems! ' # Employees: / Hours of Operation: `7
❑ Daycare # Preschoolers: # Afterschoolers: # Employees: Hours of Operation:
❑ 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 Well (# dwellings using well ) 'MUST have operable water before final
Sewage Supply: New Septic Tank (Complete Checklist) Existing Septic Tank (Complete Checklist) County Sewer
Comments:
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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 co ct to the best of my knowledge. Permit subject to revocation if false information is provided.
. _ -- () 6 / /c/ ' • •
• Signature of ner or Owner's Agent Date
"This application expires 6 months from the initial date If permits have not been issued"
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED MIEN APPLYING FOR LAND USE APPLICATION
Commercial Land Use Application Page 1 of 1 03/10
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NAME: APPLICATION #: /✓ ‘ 5.22, Z4 h C �'
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*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 APPLICATIONIS`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) 1 ey —77
910- 893 -7525 option 1 CONFIRMATION #
❑ Environmental. Health New Septic System Code: i.•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 corrner,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 schedulino'inabection:' 800 632 - 4949 (This is a free service)
• After preparing proposed site call the,vo)ce permitting "system at 910- 893 -7525 option 1 to schedule and use code
800 (after selecting notification permit ifmultipfe permits exist) for Environmental Health inspection. Please note
confirmation number alven at end of'recordlna for proof of reauest.
• 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 andcard 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; eystem 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 rimiest
• 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
(_ } { Innovative I ) Conventional 1_} My
(_) 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 I — NO Do you plan to have an ' . 'Ration svatem now or in the future?
{_ )YES { NO Does or will the building contain any di;lin ? Please explain.
{_ IYES I _ ) NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
( _I 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?
f —I YES {_) NO Are there any easements or Right of Ways on this property?
)_)YES {_} 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 Making
The Site Accessible So That A Complete Site Evaluation Can Be Performed. /
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PROPERTY OWNERS OR OWNERS LEGAL REPRESE E SIGN • RE (REQUIRED) DATE
5/08
DIAGRA OF A TYPICA SEPTIC T NK
• UTLET LID
POSSIBLE POSSIBLE
HOUSE HOUSE
CONNECTION - CONNECTION
POSSIBLE
HOUSE
CONNECTION
POSSIBLE LID SHAPES
_ I SQUARE (SHOWN ON DIAGRAM)
I ROUND
RECTANGLE (OLDER TANKS) -
How to Properly Mark Property for Soil Evaluation
(MUST MATCH SITE PLAN)
sink flag
i O. I @ iron
pink flag —►.
orange flag
4— ink flag
Legend House
iron" ®
flag
IL
range flag
pink flag
iron r, v iron
ROAD