LAND USE Initial Application Date: t"/ Z 7 r `✓ Application # / ..9 Z / a
CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.harnett.org /permits
•
LANDOWNER StIkat1 P. &1384,45 Mailing Address: AM' C4MHK,ON Mahe - WAD
City: CA On( State: NC zip: 1 Contact# 4 111i' 1%,'ZZ6&0 Email:
APPLICANT*: owthc#1PI twuceE$ Mailing Address: F0.� .Z41, 0 /
City: CttSti mmast State: AC- zip:Zf310 contact 9 l 0 - 't�1 Email: GLAha /I1SDZ yaAx.0�W1
*Please fill out applicant information if different than landowner r 1,31.4140 v
CONTACT NAME APPLYING IN OFFICE: UENNtS ' DUNAGArI Phone # 910-4 - 4740
PROPERTY LOCATION: Subdivision: 0 0 ( 100 1.04 045014s( ILLE, (•4 Lot #: a� 'A G'
Lot Size: •STA
State Road # 1I O$ / State Road Name: fJ a KU- Map Book&Page: ZOCV / 741
Parcel: DPI 56 b ✓ S 00S$ PIN: iSG . [ - q /291, `✓
Zoning:,l lFlood Zone: Watershed:�ed Book &Page: L 7 z� / i �3 Power Company *:
`New structures with Progress Energy as service provider need to supply premise number .r+ from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: DOWNS Z7 'I"0 SO kit N50Ng ita Lett 0z4
fl -n SBCoMD &o on It: 94. 2./no1 dale on rtoliast
PROPOSED USE:
❑ SFD: (Si: • Bedrooms: # Baths: _ Basement (w /wo bath): Garage: Deck Crawl Space: _slab:
(Is the bonus room finished? ( ) yes (ono w/ a closet? (_) yes (ono (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? U yes (__)no Any other site built additions? (_) yes ( )no
❑ Manufactured Home: _SW _DW _TW (Size x ) # Bedrooms: _ Garage: (site built? ) Deck: (site built? )
_A Duplex: (Size x ) No. Buildings: No. Bedrooms Per Unit:
❑ Home Occupation: # Rooms: A�1 /^� Use: Hours of Operation: #Employees:
y4), Addition /Accessory/Other: (Size 20x 0 r 0 I• ) Use:
} &ti m paws Closets in addition? ( yes ( )no
Water Supply: County Exi well ' "New Well (# 0 wellings 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 (500') of tract listed above? ( ) yes ( )no
Structures (existing or proposed): Single family dwellings: Manufactured Homes: Other (specify):
Required Residential Line Setbacks: Comments:
Front Minimum l � — Actual
f
Rear ` 4 i irg
Closest Side 0
Sidestreet/corner 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 that foregoii een�ttss,aa�re accurate and correct to the best of my knowledge. Permit subj to revo if false information is provided.
,: Signature of Owner or Own Agent Dais
**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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`i7AME: APPLICATION #: ` 1 -1 Ov 74 4 (� 5
� *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)
❑ Environmental Health New Septic Systems Test 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 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.
• 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 *plying for authorization to construct please indicate desired system type(s): can be ranked in order of preference, must choose one.
{�; Accepted {_} Innovative {} Convent', . { } Any
{_ }t Alternative {_} Other
The applicant shall notify the local health department upo • submittal of this applica on if any of the following apply o the property in
question. If the answer is "yes ", applicant must attach s .porting documentation.
{ }Y S {_} NO Does the site contain any . urisdictional Wetlands?
{ }YES {} NO Do you plan to have a trrieation system now or in the future?
1 }Y k S {} NO Does or will the bui sing contain any drains? Please explain.
{)YBS {} NO Are there any exi mg wells, springs, waterlines or Wastewater Sy ems on this property?
{ }YE. {} NO Is any wastewa r going to be generated on the site other than domes .'c sewage?
{ }YE' { NO Is the site sub' - ct to approval by any other Public Agency?
{ }YES { NO Are there a P easements or Right of Ways on this property?
{ }YES { NO Does the .ite contain any existing water, cable, phone or underground elec 'c lines?
If yes .lease call No Cuts at 800- 632 -4949 to locate the lines. This is a free -rvice.
1 Have Read his Application A • I Certify That The Information Provided Herein Is True, Complete And Corr. t. Authori.. d County And
State Officials • e Granted ":ht Of Entry To Conduct Necessary Inspections To Determine Compliance With Al • lieable L ws And Rules,
I Understand Tha • . , m • ely Responsible For The Proper Identification And Labeling Of All Property Lines And ; ners And Making
The Site Accessible So That A Complete Site Evaluation Can Be Performed.
X\ ' AND 12121h
OPERTY OWNERS OR OWNER EGAL REPRESENTATIVE SIGNATURE (REQUIRED) Vt DAT
1IIIJJJJ / 4/08
glut;
V
ii ik DIAGRAM 0 + °
• UTLET LID
POSSIBLE POSSIBLE
HOUSE HOUSE
CONNECTION - CONNECTION
POSSIBLE
HOUSE
CONNECTION
POSSIBLE LID SHAPES
1 - I SQUARE (SHOWN ON DIAGRAM)
ROUND
RECTANGLE (OLDER TANKS) -
0 2000034373
411
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.1 r AROMA GENERAL WARRANTY DEED
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Excise Tax: U
Parcel Identifier : r r i t.: t. Vaiflcdby Countyeat day of .20
By:
MaiUBox to: REGINA Ct., BOX 1118, LILLINOTON, NC 27546
This imywnent wan .... , • A t : ' LLY, 900 S MAIN STREET, LILLINOTON, NC 27546
Brie d cudption for the index. • CERTIFICATION,
THIS DEED made this 6th day •- ...:. g . 4 0 %. 20J by and between
H'. •'. �J f\ GRANTER
JOHN R. GIBBONS and wife, SHAWN PATRICK GIBBONS
KAREN J. GIBBONS 224 CAMERON HILL ROAD
222 CAMERON HILL ROAD - ERON, NC 28326
CAMERON, NC 28326
T b e d o d o : u tlm Grantor and Grantee u used haulm • 1 •,., thecheim, uccessom,aadaesige, and shalt include
alneular, phnak mascniine, f m or muter as - •
WITNESS61H,tMt the Griot°, fora valuable. •. dnrecetptofwha:h i ereby acimmwledged, has
andbyibeeepraenta damping, bargain, sell and conveyuntothe imple, all that celain lot mew:e l of land situated
lathe qty of Johnsonville HARNETT County, Nortb4mlma and
room puticulady described as follows:
See Attached
The propertyhereinebove described was icgtt by Grantor by 997 page 163 ,
A map showing die above deecribod property is minded in Plat Book _ • .
NC Ber Association Foou L3 0 1976, Revised 0 1977, 2002
Printed by Agreement with the NC Bar Association -1981 Sot1Pro , •r•••• •. Rd., Raleigh, NC 27609
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