LAND USE R Initial Application Date: 7 f /1/4 Application # 01 - SOH b 1 21_, 4
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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/pernits
LANDOWNER: 7- 7- J 3.& h Mailing Address: $ oak_ .cf,
City: L ; /li.h- State:N•C' Zip: 2- 7S 9 8 / -7Lf7 Email:
APPLICANT': J P 7 T R p e- Mailing Address: S.S1 A n/ril i? ur c5 rt tom( •
City: ,44_ ?-e,— State/V Zip:?791 Contact# SID - b'/4 - 7"t 7 5 Email:
*Please fill out aldplicant information if different than landowner nn
CONTACT NAME APPLYING IN OFFICE: r , 1-e_ Phone # e t 1 n •- &'1 ' 7
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PROPERTY LOCATION: Subdivision: 4l7 ' /41(7.0\--- Lot #: Lot Size:
State Road # .7.:-/A <;- State Road Name: 11 b y vt 84. ter)-, ( % Map Book &Page: /
Parcel: l ,) Os3°l OO•. h 3 PIN: OS - AO- - O, ? /Lf , O00
Zoning:At 30 Flood Zone: Watershed: Deed Book &Page: 277 / S S. Power Company *:
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: A a _ ■ z ro'I
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Ge_St B / 0 i-• /ZD rA6 L....1 r� ✓Y•i le .c) 0_ 1_! .
PROPOSED USE:
I t 7/{, Monolithic
L - / SFD: (Size -r a bath):_ Garage: "-----.. _ Deck:_ Crawl Space: ✓ Slab:_ Slab:_
(Is the bonus room finished? (C -' yes (Jno 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? (-__) yes (_)no Any other site built additions? (__) yes (__)no
❑ Manufactured Home: _SW _OW TW (Size x ) # Bedrooms: Garage: (site built? ) Deck: (site built? )
❑ Duplex: (Size _x ) No. Buildings: No. Bedrooms Per Unit:
❑ Horne Occupation: # Rooms: Use: Hours of Operation: #Employees:
❑ Addition/Accessory/Other: (Size x ) Use: Closets in addition? L) 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) 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? L) yes ( )no
Structures (existing or proposed): Single family dwellings: Manufactured Homes: • /Other (specify):
Required Residential Prrop rrty Line Setbacks: Comments: 4,4•••• / - Z - /O Maine&, OTD144c,
Front Minimum ,/ Actual /7"
Rear '2 ✓ 4 D / 7 /
Closest Side / 3 ✓ `
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.
1 hereby state that foregoing stateme are accu to and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
7
n ot er or Owner's Agent Date
his aapplicatlon expires 6 months from the initial date If permits have not been issued"
A RECORDED SURVEY , RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
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NAME: APPLICATION #: Po /d / ✓ / z- L
*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 1S ALTERED, THEN THE IMPROVEMENT
PERMIT OR AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. The permit is valid for either 60 months or without expiration
depe mg upon documentation submitted. (complete site plan = 60 months; complete plat = without expiration)
910 - 893 -7525 option 1 CONFIRMATION #
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 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 scheduling inspection. 600 632 - 4949 (This is a free service!
• After preparing proposed site call the voice permitting system at 910 -893 -7525 option 1 to schedule and use code
800 (after selecting notification permit if multiple permits exist) for Environmental Health inspection. Please note
confirmation number given at end of recording for proof of request.
• 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 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
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 please indicate desired system type(s): can be ranked in order of preference, must choose one.
{_) Accepted {_} Innovative (t!) Conventional (_} Any
[_) 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 { —) NO Do you plan to have an iftigaiinasYS1 m now or in the future?
{_)YES La NO Does or will the building contain any [,'tills? Please explain.
1 (yerNO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
{_)YES is j- Is any wastewater going to be generated on the site other than domestic sewage?
{_ }YES ( Is the site subject to approval by any other Public Agency?
(_ }YES {'NO Are there any easements or Right of Ways on this property?
(_ }YES {tA(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.
1 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 Corn lete Site E luation Can Be Performed.
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PROPERTY OWNERS 0 O ILGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
5/08
How to Properly Mark Property for Soil Evaluation
(MUST MATCH SITE PLAN)
•
•ink flag
le
i• n iron
pink flag —►. orange flag
1 i •— ink flag
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Legend House
irox
tilt
flag
ag
range flag
pink flag
iron G u iron
ROAD