ENVH Refunda
i'
NORTH CAROLINA
Account Number:
Project Number:
Vendor Name:
Vendor Number:
Remittance Address:
Date: May 22, 2014
110 - 0000 - 345.18 -00
Guy & Judith Gardner
4503 Ross Road
Lillington, NC 27546
❑X Mail to payee
Check to be picked up by:
(Requires approval of Finance Officer)
Approved: Disapproved:
Reason for check request: No existing tank necessary due to new tank installation within approx. 30 days
per Oliver Tolksdorf. Location of proposed 40 x 32 garage will not affect system
or drain field area.
This check request has been examined by me and is hereby approved for payment.
Department Head or uthorized Designee Date
Graham H. Byrd, R.E.H.S. >
Ain ument has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
Description
Amount
Existing Tank Fee
$ 100.00
Location: 4503 Ross Rd
Application # 14 -5 -33715
Total Amount Due
$ 100.00
Reason for check request: No existing tank necessary due to new tank installation within approx. 30 days
per Oliver Tolksdorf. Location of proposed 40 x 32 garage will not affect system
or drain field area.
This check request has been examined by me and is hereby approved for payment.
Department Head or uthorized Designee Date
Graham H. Byrd, R.E.H.S. >
Ain ument has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
al,--- ' ( j%
Initial Application Date: ' 2- -) 4
Central Permitting
Application #, 591 . l-�
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION yLm
108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 ext:2 Fax: (910) 893 -2793
"A RECORDED SURVEY MAP, RECORDED DEED (OR( OFFER TO PURCHASE) & SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE
LANDOWNER:_v? u�� )(I�C1y�Qii Mailing Address: U�Gn3 _?C+S`�OC�
City: U!l ;na xl State: ('�'r Zlp;'alt 4L Contact No: _919 ,SSG °r)'t/t// Email: QjA e,'
APPLICANT*:— „�u N a �; '1;�a1'rY, Ci(Afa-W Mailing Address:
City: i l' State: IL ZlpeI�„�6 Contact No: 9 / Email:
'Please no out a0plicidil information ff different than landowner
CONTACT NAME APPLYING IN OFFICE:, i� ill! 1t .i Phone N
PROPERTY LOCATION: Subdivision:
State Road # State Road Name:
Parcel: i J % PIN: !�
r' --
Zoning:-W2 Flood Zone: Watershed:, Dead Book & Pager
'New structures with Progress Energy as service provider need to supply premise number
PROPOSED USE:
Lot
to rGrV-h Qd wl ", O vU
G�
rc:t� ii v
t I
is
Lot Size: f
Book 8, Pa_ e: z X /
Company:
from Progress
❑ SFD: (Size ___.x } # Bedrooms:— # Baths:` Basement(w/wo bath):_ Garage:' Deck:— Crawl Spacer Slab: —
(is the bonus room finished? (_,_) yes (_) no wl a closet? (^) yes (_j no (if yes add in with # bedrooms)
❑ Mod: (Size x } # 9edrooms^ #Baths_ Basement (wlwo bath)_ Garage:_ Site Built Deck:_,,, On Frame_ Oft
(is the second floor finished? (__•_) yes (_) no Any other site built additions? (__) yes (-J no
no
Manufactured Home: _„_SW , _DW —TW (Size - ,may # Bedrooms: _ Garage — (site built7 ) Deck:_(site built?
• Duplex: (Size x) No. Buildings: No, Bedrooms Per Unit:
• Home Occupation: # Rooms: Use: Hours of Operation: #Employees: 11
Addition /Accessary /Other: (Size) Use: l/� -lsr -f. (. C LL. Closets in addition? es
(_)y ( 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 (Carnplete Checklist) County Sewer
Does owner of this tract of land, own land that contains a manufactured home within five hundred feet (5001) of tract listed above? (_) yes (Y) no
Does the property contain any easements whether underground or overhead (yes ( ) no
Structures (existing or proposed): Single family dwellings: Manufactured Homes: - Other (specify):
Required Residential Property Line Setbacks: / Commence � � ., n: �✓1
Front Minimum ' ` Actual_ Isle"
Rear
Closest Side 0
Skiestrest/comer lot `�-
Nearest Building
on some lot.
Residential Land Use Application
Page 1 of 2
APPLICATION CONTINUES ON BACK
03/11
BP821UOI Harnett County 5/22/14
Application Fees Maintenance 10:15 :09
Application number . : 14 50033715
Address . . . . . . : 4503 ROSS RD
Position to . . . . .
Type options, press Enter.
1= Select
Amount
Opt To Apply Description
.00 CP* MISCELLANEOUS
.00
25.00
.00
250.00
25.00
.00
10.00
_75.00
CREDIT /DEBIT PROC. FEE
ENVIRON HLTH REVISION FEE
EV* REINSPECTION FEE
EV* WELL FEE
EV *RETURN TRIP FOR SEPTIC
EXIST. TANK TEST /INSP.
HOMEOWNER RECOVERY FUND
LAND USE RENEWAL
F3 =Exit F9= Display all F12 =Cancel
10
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