LAND USE Initial Application Date: q ^ 4 Application # / r ! - P92 1 /7,2 (� O
DRB # CU #
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting 108 E. E. Front Street, Street, Lillington, NC 27546 /}r Pine: (910) 893 -7525 6 �� /1, Fax: (910) 893-2793 893 - X 27 / 7 93 www..harnett.orgg /permits
LANDOWNER:LOI /.1 R. , ern mil. Fri-NI ' Mailing Address: /7- L� )214 )"OM'I4tJtJ l if
City: State: Zip: Contact # Email:
APPLICANT*: S,40t -[_., Mailing Address:
City: State: Zip: Contact # Email:
'Please fill out applicant information if different than landowner c(„ 91 9. y Jy ` b-'
CONTACT NAME APPLYING IN OFFICE: 24511N / VY4,.1 i S / Pho # / 7
PROPERTY LOW ION: Subdivision: I SL Q04 1 �: RZ 1 j�'�GM#"4J •Lot #: / Lot Size: / ✓? -
9 7./ J /^z�
State Road # / L /r Sta Road Name: / `+' . . /r / Map Book& &Page: /!/t/
Parcel: 91 S /� 041 A ✓ f PIN: 947o 7� 54- 7 �J7 aaC
Zoning: � 2 a ad Zone:_ Watershed: e/ /f/Deed Book &Page: 1/ 57, 6 7� 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. � IU 4)... i-' t a t run d( 0 - iS W
/ �t 3- Ss.; ti oC C for Akb — /`l
trn !J'4r.. 4J- 5l' 1L'10 f l- A $I>
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3 41k/it Bit f idye .•
PROPOSED USE:
❑ Multi - Family Dwelling No. Units: No. Bedrooms /Unit:
❑ Business Sq. Ft. Retail Space: Type: # Employees: Hours of Operation:
❑ Daycare it Preschoolers: # Afterschoolers: # Employees: Hours of Operation:
❑ Industry Sq. Ft: Type: # Employees: Hours of Operation:
❑ Church Seating Capacity: *Bathrooms: Kitchen: 1 -% Accessory/Addition/Other (Size x # 2-14 ,t' Use: ,, t. J. . �,� ♦ I. 1 !1•i /
• 64.-n. - �.}.) bete V Ye-!,S . .
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
Comments:
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 statemennts are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
Signature of 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
Commercial Land Use Application Page 1 of 1 06/10
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AME: net R•1d- /1.Cr•-00t A Y4r/If e/ I U 0 c h APPLICATION #: /9 /' 9a. Z 9 O".
•
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 #
❑ Environmental Health New Septic System Code 800
• All property irons must be made visible. 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.
• All lots to be addressed within 10 business days after confirmation. $25.00 retum trip fee may be incurred
for failure to uncover outlet lid. mark house corners and property lines. etc. once lot confirmed ready.
• 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 recordlna 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 outlet end of tank as diagram indicates, and lift lid straight up (if
possible) and then close back down. (Unless inspection is for a septic tank in a mobile home park)
• After uncovering outlet end 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
plven 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 pr - - nce, must choose one.
{ • ccepted { Innovative {_} Conventional { Any
{_} Altern• ' { Other
The applicant shall no he local health department upon submittal of this a.. ' ation if any of the following apply to the property in
question. If the answer is "ye •.•plicant must attach supporting docum• • .tion.
{_ }YES {} NO Does the site con • any durisdictio.:. etlands?
{ }YES {} NO Do you plan to have an '1_:•. - : n now or in the future?
{_ }YES {_} NO Does or will the buil.' - : contain any de.,:. 9 Please explain.
{ }YES {} NO Are there any , !sting wells, springs, waterlines or • : - water Systems on this property?
{ }YES {} NO Is an : tewater going to be generated on the site other than • o : ' 'c sewage?
{_ }YES {_} NO s the site subject to approval by any other Public Agency?
{_} YES { 10 Are there any easements or Right of Ways on this property?
{_ }Y : { 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.
1 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 REPRESENTATIVE SIGNATURE (REQUIRED) DATE
DIAGRAM O F ' CAL S • IC TANK
--- 1
dr .
• U - LID
POSSIBLE
HOUSE POSSIBLE
CONNECTION HOUSE
CONNECTION
POSSIBLE
HOUSE
CONNECTION
POSSIBLE LID SHAPES
I _ I SQUARE (SHOWN ON DIAGRAM)
o 0 (OLDER TANKS) Q ROUND
How to Properly Mark Property for Soil Evaluation
(MUST MATCH SITE PLAN)
, ink flag
�a G Iron
•
Fink flag —4' Orange flag
1 i , 4— ink flag
1�
Legend ,
itod"
flag
}
ge flag
Pink flag
iron r. iron
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