LAND USE Initial Application Date: - 7- 9 -/7) Application # /2 5 -10 2-4
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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 ww
w.hamett.org/permits
LANDOWNER: 3 %m ml krd Mailing Address: '3VC0 / e_cel 40,4 40,4 ,+ - l �l. Mo
City: .gr7}n.1l„r0. Stater%.. Zip: $ Contact # ST , B 1 rr/ Email:
APPLICANT*: . �; .. & rr ,/ Mailing Address: 3H rU LpJ'/ h R-L
City: r.J row- .+ State: AC Zip: 2-75`i7 Contact # SG,-n Email:
'Please fill out applicant information it different than landowner
CONTACT NAME APPLYING IN OFFICE: - 3 - l M N
& I d Phone# L (�i�%- ?-4 2-Y PROPERTY LOCATION: Subdivision: SE. . .._ r d �Slcf Lot #: C( 3 Lot Size: D .Co 9
State Road # 2 9 35 State Road Name: S 4 0C k yG-I L / �j �J(y . Map Book &Page: 6 /5 /
Parcel: / 9 6 / _ 1 0c44 - 0/ PIN: 95 7 — 3 / - / ��� Off✓
Zoning: (4 4 P4lood Zone: X Watershed:�L.l�-- Deed Book &Page: / YJ 7 32 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: o( 30 LAC4A ,j. o C/z r k.r -,/ R r (rak R - ma p/
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RO OSED USE:
Monolithic
SFD: (Size .$_v x 52) ) # Bedrooms: 5# Baths: ZBasement(w!w th): Garage: Deck: Crawl Space: Sla Slab:
(Is the bonus room finished? ( ) yes ( o w/ a closet? U 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? (J 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:
❑ Addition/Accessory/Other: (Size x ) Use:
Closets in addition? U yes (ono
Water Supply: ) County _ Existing Well _ New Well (# of dwellings using well ) *MUST have operable water before final
Sewage Supply: )C New Septic Tank (Complete Checldist _ 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? U yes ( )no
Structures (existing or proposed): Single family dwellings: YO Y t Manufactured Homes: Other (specify):
Required Residential Property Line Setby Comments:
Front Minimum �( Actual i
Rear Z r 2o7
Closest Side / ( 2 0
Sldestreet/comer lot
Nearest Building
on same l01
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 correct to the best of my knowledge. Permit subject to revocation if false information is provided.
(J Sign4ture df Owner 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 WHEN APPLYING FOR LAND USE APPLICATION
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NAME: APPLICATION #: f " 4 2' U ai
*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
depe ing 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 A/o 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 option 1 to schedule and use code
800 (after selecting notification permit if multiple permits exist) for Environmental Health inspection. Please note C v
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. V
❑ 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 {vTonventional {_} 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 irrieation system now or in the future?
{_)YES ( ') NO Does or will the building contain any drains? Please explain.
{ [ II NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
{_ }YES ( ) NO Is any wastewater going to be generated on the site other than domestic sewage?
{_ }YES (4.) NO Is the site subject to approval by any other Public Agency?
( �_rrrrr''' )YES {4t} NO Are there any easements or Right of Ways on this property?
{.yYES (_} 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.
PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIV) $ GORE (R EQUI RED )
DATE
V 5/08
How to Properly Mark Property for Soil Evaluation
(MUST MATCH SITE PLAN)
ink flag
1 (;1 iron
pink flag —+ . orange flag
4— ink flag
Legend House
fro,
fl al►
ag
range flag
pink flag
iron c iron
ROAD