LAND USE Initial Application Date: t O - 17 / D Application # ` a fcg L ‘✓ 2
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permittingg 108 E. , FFro _ nt Street, Lillington, 27546 Phone: (910) 893 -7525 Fax: (9�10) 893 -2793 � nwww.hamett.org/permits
LANDOWNER: C I I "Z��l. 1JLV-� 1 LO\h Q_(� 2 Mailing Address: CA \S`l 0 �'l �lS.�
City: CNrci Sttaaatee,J'( Zippr�r )Contact # te. �r-j Email: ��
APPLICANT': ,f )S v :L ¢ ,3. Mailing Address: r4 /' ! 4P ESL... - f•1 'I k
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City: AIMS • Statj/'ll. Zip Contact L(/) Am �T Email: j P.� t-� reerl.r kit. it. k COR
'Please fill out applicant information if different tha ` (� q Q �"
CONTACT NAME APPLYING IN OFFICE: fl 1C ow . , " �� C.� -+Y Phone # `�� °) �I I ' - r-- / r ( y �7
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PROPERTY LOCATION: Subdivision: 5; C /.F i Lot 15 Lot 4/.4 Size: / 7)
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State Road # State Road Name: / 4 p j // /J 7 9/ % 7( / 4 / Map Book &Page: I
Parcel: 0 A a 7 c ✓/7 `J , 7 PIN: I p - (,G,
Zoning: Z ✓ food Zone: Watershed: ,( /� Deed Book &Page: I D I / / 07 V N P4
Power Company*:
*New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
Y. SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Cl ck a cr 2E` f,4. C\C
it .1 t • ) ' s_ U _.. \a /L a DI 1
lb a rs.. $tt► • % al • lk • ! a \ , 04. — Jb ,•
PROPOSED USE:
❑ SFD: (Size _x # Bedrooms: _ # Baths: _ Basement (w/wo bath): Garage: Deck: Crawl Space: _ Slab:
(Is the bonus room finished? (_) yes (_)no wI a closet? (_) yes (_)no (if yes add in with # bedrooms)
❑ Mod: (Size x) # Bedrooms # Baths_ Basement (w /wo bath) Garage:_ Site Built Deck: On Frame_ Off Frame_
(Is the second floor finished? ( ) yes (_)no Any other site built additions? ( ,) yes ( )no
❑ Manufactured Home: _ SW _ DW _ TW (Size x_) # Bedrooms: Garage: (site built? ) Deck: (site built ?)
❑ Duplex: (Size _x_) No. Buildings: No. Bedrooms Per Unit:
❑ Home Occupation: # Rooms: Use: Hours of Operation: #Employees:
/IA Addition /Accesso /Other: (Size q x 19 ) User -FTYl p Closets in addition? (_) yes (_)no
'Water Supply: County _ Existing Well New Well (# of dwellings using well _) *MUST have operable water before final
Sewage Supply: New Septic Tank (Complete Checklist) X Existing Septic Tank (Complete Checklist) County Sewer
Does owner of this tract of land, own land that contains a manufa btur home within five hundred feet (500') of tract listed above? (_) yes )no
Structures (existing or proposed): Single family dwellings: ice,♦ , 2 t Manufactured Homes: Other (specify):Ltajd,0
Required Residential Property Line Setbacks: Comments:
2 " D
Front Minimum / Actual
Rear 2 f i 1 ,39
Closest Side / Z 0
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 t ereg i g stet ants are a ate and correct to the best of my knowledge. Permit subject to revocati n if false information is provided, CI
ignature of Owner or wner'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 WHEN APPLYING FOR LAND USE APPLICATION
Residential Land Use Application 1 of 1 03)10
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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 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)
E1 Environmental Environmental Health New Septic Systems Test C 8 910 8,3 75" l �� 7
• Place "pink property flags" on each corner iron of lot. All propel nes must be clear] flagged approximately
every 50 feet between corners.
• • Place "orange house corner flags" at each corner of the structure site. Use additional flags to outline driveways,
garages, decks, out buildings, swimming pools, etc. Place flags per site plan developed at/for Central Permitting.
• Place Environmental Health "orange" card in location that is easily viewed from road.
• 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 and use code 800 (after selecting
notification permit if multiple permits) for Environmental Health confirmation. Please note confirmation number
given at end of recording for proof of request.
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• Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting for permits.
Environmental Health Existing Tank Inspections Code 800
• Place Environmental Health "orange" card in location that is easily viewed from road. Follow above instructions
for placing flags 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 & select notification permit if multiple
permits, then use code 800 for Environmental Health confirmation. 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 ple, . •'cate desired system type(s): can be ranked in order of pref ence, must hoose one.
{_} Accepted { Innov. the { Conventional {_} Any
{_} Alternative {_} •
The a plicant shall notify the loca ealth departmen upon submittal of this application if any of the , ollowing apply to the property in
questi n. If the answer is "yes ", s plicant must attac supporting documentation. 1
l
{} S {} NO Do-. the site contain any risdictional Wetlands?
{_} S {_} NO D. you plan to have an • r • , . • I , • _ • o now or in the future?
{_} 5 {_} NO r oes or will the building c. ntain any drains? Please explain.
{_ }YE { NO Are there any existing well springs, waterlines or Wastewater S stems on this property? \
{_ }YE {_} NO Is any wastewater going to 1- generated on the site other than d• mestic sewage?
{ }YE {_} NO Is the site subject to approval .y any other Public Agency?
{_ }YES {_} NO Are there any easements or Right of Ways on this property?
{_} YES {_} N • Does the site contain any existin: water, cable, phone or derground electric lines?
If yes please call No Cuts at 800 2-4949 to locate lines. This is a free service.
I Have Read ' his A. placation And Certify That The Information P : ided Her' i Is True, Complete And Correct. Authorized County And
State Officials re ranted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I Understand That I Am Sol y Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Sit + ;',le r , omplete Site Evaluation Can Be Performed.
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( :yi1' , 1W 'IRS OR OWN ' LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
• 4/08
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DIAGRAM OF A TYPIIAL SEPTIC TA
,-- 7 Irla
• ID
POSSIBLE POSSIBLE
HOUSE HOUSE
CONNECTION _ CONNECTION
- -►
POSSIBLE
HOUSE
CONNECTION
POSSIBLE LID SHAPES
1 , I SQUARE (SHOWN ON DIAGRAM)
RECTANGLE (OLDER TANKS) ROUND
How to Properly Mark Property for Soil Evaluation
(MUST MATCH SITE PLAN)
ink flag
•_
i • r.' n iron
pink flag ---► orange flag
, 4— ink flag
Legend House
iroP
flag
ag
range flag
pink flag
iron r ® iron
ROAD
06988 JILL BOOK I L PACE °�rt� < nglonla '93 JUL ' 1 PR 2 27 TAX PARCEL NO. 030507 0183 14
VIM, WIGGINS, CLEVELAND 6 RAPER, PO ROE 35147, PAtRTBVILLE NC 78303
GAYLE P. HOLDER
7, =GISTER OF DEEDS WARRANTY . DEED
HAEHETT COUNTY, NC
•EED, made this 39Ta day of JUKE ,1993
:� «: an• WWILL/AX R. BROWN,
I
PARTNERS D /B /A INVESTMENTS
VNNLIM u AD, A 7 r • 1 partnership
erein ea d ll it
to FRED E. rt'R' ! ryFE, ELIZABETH A. LOTEERY, 10116 S76NEY CREEK DR. SANPORD!
w V NC 27330
herein called -• t of said state and County
w1TBa96� TWAT O ten dollars and other valuable considerations hereby
acknowledged as pai has bar and sold, and by those prevents doss grant,
bargain, sell and i and � �tee, bi. hars an assigns, certain land described as
follows: <
NORTE CAROLINA, :,. i IN88IP OP BARBECUE •
BRING all of Lot n a Subdivision knamn as STONEY CREEK
MANOR, SECTION •,<: ••i•. to a plat of the same duly recorded
in Plat Cabinet P} : e D and 65D -A, Harnett County, North
Carolina, Registry. � . .g he same property conveyed to
Grantor by Deed r- • -ii.y in : 1011 , Page 123 - 124 ,
aforesaid rOgistry.
This conveyance is made subject - • re covenants, easements and rights of way which
say appear of record as well as • /cable ci /County coning rules, regulations or
ordinances. purther, this convey subject currently accruing 1993 ad valor
property taros which the grantee • .. agrees • pay.
TO HAVE AND TO SOLD, said land and all - ivi •" s ••• appurtenances thereto belonging,
to Grantee, his heirs and assigns forever - covenants with Grantee that ha is
seised of said praises in fee and has .. ri• • - in fee simple; that the same ars
free and clear of all encumbrances (elm a' roinabove stated), and that he does
hereby forever warrant and will forever • 1••• the tie to the same against the lawful
claims of all persona wboasoever.
Whenever used herein, the singular shall •- ude t'e .Mural, and the use of any grader
shall be applicable to all ganders as the coat -• re. re.
IN TESTIMONY WH8REOP, Grantor has , ghsB sealed this deed.
YWA:• ^'TR RECCROEO IN Tmg S COMP .• t: : ' ' WILLIAM R. BROWN,
ARNETT COMP P .. t: /A INVESTNERTS
YAM SUPERVISOR um,•• Nt`� NEUTRAL PARTNERSHIP
' eNbl_caZa{��R --`ti Bre [� • .4.,`�_ (S EAL )
41 . PARTNER
ft Arc, I BYe j,' a • : a.,
W tin , PARTNER
STATE OF NORTH CAROLINA - COUNTY OP CUMBERLAND
, =x71
G t ' 8. HUGHES, a Notary Public of said Co t• a S to do hereby
,L. P
PIERCE AND WILLIAM R. BROWN, : . D/8 A • B�1
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a 4 - ai <. 7 ; < MN=AL PARTNERSHIP personally appear - • b. o e . , this da
:df- M:a:_; .n. the due execution of the foregoing in •. t.
° .i f e c Lr : 7 ' . • and Notarial Seal, this the 30 . , ay • � •yl>
1C'. �.. 'i- N ot %C ilia
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HARNETT COUNTY 97-9E -9 4,41
STAT $1.85_0 0 rata of — �WII�II��I���W 4
91 € Real.Estate
G 4 o Excise Tax 9306988