LAND USE 0 24‘
Initial Application Date: 4-. — 21.-1 V Application #
CU#
COUNTY OF HARNE1T RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 27548 Phone: (910) 893 -7525 Fax: (910) 893 -2793 wv.w.hamettorg/permits
LAND • WNE' . ..- 1 1 _ , . .&-L ' 0 . A. g ,u. Mailing Address: `P 1 r „1 ?.!)' "1 1
City: ie State: /V ( Zip:",57 /Contact # 9 56 - q 6 mail:
APPLICANT*: I G.e. .e. . _ 1 1 —.. Mailing Address: PI), t 9 C - 3
City: • .a State .0 Zlp: 15 7 Contact # 910 - 1 ? ` YO$ Email:
'Please fill out applicant information if different than la o, wner -
CONTACT NAME APPLYING IN OFFICE: !1/..P , G ) t alA -.vt4) Phone # 9/ -793 4 D !/ U / /
PROPERTY LOCATION: 5 S bdlvislon: I "-lit./ a ... (9 Lot #: � Lot Size: Zii /
State Road # 1 �j State on Name: �i /L' /l��
/ Map Book8Page:7 / I / l d - 6
Parcel: q ✓ 44P (/ 0 7 /4 PIN: ✓bZ/ — Q 5 S — � OV!4. OG S �
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Zoning: 7 1( / Flood Zone: Watershed: (J
Deed BookBPage: A .4 -4 / / / 9 Power Company:
New structures with Progress Energy as service provider need to supply premise ` se number I from Progress Energy. / /�
SPECIFIC DIRECTIONS TO THE PROPERTY, FROM LILL NGTON: 0 n A 1 r / 11 a 1 1) 7g.z -x. .(r 7t, - ritly t aY i
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PROPOSED USE:
❑ SFD: (Size x) # Bedrooms: _ # Baths: _ Basement (w/wo bath): Garage: Deck: Crawl Space: _ Slabi
(Is the bonus room finished? (_) yes (_)no w/ 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 ALDW TW (Size S' #__3_a) # Bedrooms: Garage: (site built ?) Deck: (site built? )
Duplex: (Size _x ) No. Buildings: No. Bedrooms Per Unit:
❑ Home Occupation: # Rooms: Use: Hours of Operation: #Employees:_
❑ Addition /Accessory/Other: (Size x) Use: Closets in addition? (_) yes (_)no
Water Supply: _ County Existing Well New Well (# Sings using well ) *MUST have operable water before final
Sewage Supply: _ 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 ( //(((��00''yof��tract listed above? (___) yes (! )no
Structures (existing or proposed): Single family dwellings: Manufactured Homes: kr-. Other (specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum 2 Actual / (
Rear L' / 33
Closest Side /a 22
Sidestreetlmmer lot
Nearest Building
on same lot
If permits are granted 1 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 forego 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 Owner or Owner's Agent Date
"This application expires 6 months from the Initial date 11 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 03110
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SITE PLAN( APPROVA A""- y�i�l �
�0 USE aid- 11 - 17/3Z "'
DISTRICT 2,
*BEDR00MS 1L-- --- ` - - - ---
�, Zoning Mini istrator
N --.L Date
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NAME i.., s APPLICATION #: 10y5C0-241(05(0
*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 # 1 C i
❑ 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 bard in location that is easily viewed from road to assist in locating property.
“1 , , .
...- .2;3 • If property is thickly wooded, Environmtal 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 servicet
' • After preparing proposed site call the voice, permitting system at 910-8937525 option 1 to schedule and use code
800 (after selecting notification permit if multiple permits exist) for Environmental Health inspection. Please note
confirmation number Alan at end of recording for proof of reauest.
• • Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
Environmental Health Existino 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
elven at end of recording for proof of , • nest:
• Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting for remaining permits.
SEPTL,
If applyi : for authorization to construct please indicate desired system type(s): can be ranked in order of preference, must choose one.
(_I Accept • {_} Innovative 1_) Conventional I_} Any
(_} Alternative {_} Other
The applicant shall notify • - local health department upon submittal of this application if any of the following apply to the property in
question. If the answer is "ye " applicant must attach supporting documentation.
(_)YES (_) NO Does the s .- contain any Jurisdictional Wetlands?
(_)YES (_) NO Do you plan to e an jrtivatien system now • the future?
{_)YES (_) NO Does or will the buil• contain • . • .' i:? Please explain.
(_I I NO Are there any existin_ . - s, • 'rings, waterlines or Wastewater Systems on this property?
(_) YES (_) NO Is any was er going to be gene . d on the site other than domestic sewage?
{_)YES f _) NO : e site subject to approval by any other blic Agency?
(_)YES 0 Are there any easements or Right of Ways on dm • .perty ?.
(_)YES (_) NO Does the site contain any existing water, cable, phone o nderground 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 1 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. I c
PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIV SIGNATURE (REQUIRED) DATE
5/08