DOCUMENTS From: 11103/2014 13:47 #309 P.001 /004
Initial Application 0ate: y
Application 1 CXD
1 -1 I L-1 ft S
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION COI
Central PemittIng 108E.Front Street,LIIIIngton,NC 27548 Phone:(910)883.7525 ext:2 Fax:(910)893-2793 www.hamett.org/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)k SITE PLAN ARE REQUIRED WHEN SUBMMI G A LAND USE APPUCATION"
LANDOWNER:. <Q ll kE d AALe`` fC J g' Mailing Address. 1 4'1 1 i'2
City:S Qr V-O r'fl StaM�S Zip at Contact No: 1'1 "1' "1 4 Emell:
APPLICANT f di)'QZ _ gAddress.2-% 00L»
City: ¶Y c C + '1.3 Stat6A C ZipZ -31 Contact No: b‘1).4121 03 Email: •
'Please Aft outappkrnt information If diferent then landowner
CONTACT NAME APPLYING IN OFFICE: Phone It
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PROPERTY LOCATION:Subdivision: ^ Lot tit:� Lot Size:�q•S4
Ole Road N f L C) (. State Road Name: A3 C. , e Map Book&Page: A-
.• •egs- 335 . 0 0 0 CI 0 l 6')•
zr13 g! a Flood Zone: NIZ Watershed: Deed Book&Page:!6-1 /3-A Power Company:
New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: •
SFD:(Size__x )P Bedrooms: it Baths:_Basement(w/wo bath): : Space: Slab: Sla
^Garage: Deck Crawl Monolithic rhic
b:
(Is the bonus room finished?( )yes (_J no wl a closet?( )yes ( )no(if yes add In with It bedrooms)
❑ Mod:(Size x )It Bedrooms_at Baths Basement(w/wo bath)`Garage: Built Deck: On Prime Off Frame
/ (is the second floor finished?.(J yes ( )no Any other site built additions?(_J yes (_)no
fi Manufactured Home:_SW/OW_TW(Size GO :CJ )N Bedrooms:Garage:___(site built?____)Deck: (site buik?
O Duplex: (Size s )No.Buildings: No.Bedrooms Per Unit:
O Home Occupstan:It Rooms: Use: 'Hours of Operation: #Employees•
O Addition/Accessory//O Other.(Size x }Use: Motets In addition?( )yes (�no
•
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Water Supply: \bounty Existing Well New Well(Not dwellings using well )`Must have operable water before final
Sewage Supply: New Septic Tank(Complete Checklist) t,/,Existing Septic Tank(Complete Checklist) County Sewer
Does owner of this fact of lend,own land that contains a manufactured home within five hundred feet(500)of tract listed above?(_)yes (_r)no �I
Does the property contain any easements whether underground or overhead(_)yes (_J no ,
Structures(existing or proposed):Single family dwellings:Lp>C'� Manufactured Homes: 4- Other(specify): Lst.-
Required Residential Property Line Setbacks: Comments:_
Front Minimum Actual 1 J 1
Rear
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Closest Side
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Sidestreet/corner lot r
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Nearest Building 1 [a'7 •
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
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rruln: + 11 /03/2014 13:48 #309 P.002/004
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SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINOTON: • t L' ' W / 1 Q 1),JA.r-b
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If permits are granted I agree to con rm to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
hereby state that foregoing tatemen a accurate an�the best of my knowledge. Permit subject to revocatio false information is provided.
gnatu of Owner or Owner's Agent Date
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—"It Is the owner/applicants responsibility to provide the county with any applicable information about the subject property,Including but not limited
to:boundary information,house location,underground or overhead easements,etc.The county or Its employees are not responsible for any
incorrect or missing information that is contained within these applications.***
• "This'application expires 6 months from the initial date if permits have not been issued**
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NAME: am0e r IQ `1,S _ APPLICATION#:_
*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 SystemCode 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 underclrowth 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 return 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 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 outlet end of tank as diagram indicates, and lift lid straight up (if
possible) and then put lid back in place. (Unless inspection is for a septic tank in a mobile home park)
• DO NOT LEAVE LIDS OFF OF SEPTIC TANK
• 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
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
applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference,must choose one.
{_ Accepted {__I innovative {_} Conventional (_} Any
{ ) A •rnative I__) Other_—
The applicant all notify the local health department upon submittal of this application if any of the following apply to the property in
question. If the• .wer is"yes",applicant MUST ATTACH SUPPORTING DOCUMENTATION:
I__IYES {_) NO foes the site contain any Jurisdictional Wetlands?
{__}YES (_) NO Do Ilan to have an irrigation system now or in the f .
{__}YES {_I NO Does or wi . building contain any drains? ' se explain._ —_--
I IYES ( l NO Are there any exist' : wells. sprin_ • aterlines or Wastewater Systems on this property?
{_)YES 1_1 NO Is any wastewater going to : enerated on the site other than domestic sewage?
{_)YES {_I NO Is the site subjec . approval by an er Public Agency?
{__)YES {_I NO Are ther• . y Easements or Right of Ways o 'is property'?
{__}YES I_I NO P e es the site contain any existing water,cable,phone . underground electric lines?
If yes please call No Cuts at 140(-632-4949 to locate the lines. ' I's is a free service.
i Have Rea. is Application And Certify That The Information Provided Herein Is True,Complete • Correct. Authorized County And
St. fficials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With • • . ' Mc 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 A essibl t A Complete Site E aluation Can Be Performed.
PE OWNER OWNER. LE PRESENTATIVE SIGNATURE (REQUIRED) ATE
r((( 10/10
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Date: k(- 7 -0- Application#
PROCEDURES AND GUIDELINES FOR MANUFACTURED HOME INSPECTIONS
RA-20R& RA-20M Certification Criteria
I,tp C r Hoer er.5 , understand that because I'm located in a RA-20R or RA-20M
Zoning District and wish to place a manufactured home in this district I must meet the following criteria,
verified by zoning inspection approval, before I will be issued a certificate of occupancy for this home.
1. The home must have a pitched roof, for a manufactured home, whether A-shaped or rounded,
which has a minimum rise(measured at the center of the home)of twelve (12) inches for every
seven (7) feet of total width of the home. (Example: A home measuring fourteen (14 ft.) in
width must have a twenty four(24) inch rise as measured from the center of the roofline to the
baseline of the roof.) (See Illustrations Below.)
241 Minimum `f; 24"Minimum , .
A•Shaped Rounded
Roof Pitch Rise ', Roof Pitch Rise
1 &.',,asete :" 1 :r.
x
14'In Width 7
03'
1.? 20U)
Note: Most Rounded Roofs Will Not Meet The Roof Pitch
Requirement As Illustrated. The Measurement From The Peak Of
The Roof To The Base Line Of The Roof Must Be 12" For Every 7'Of
Total Width Of The Home. (Ex: 14'Wide Home=24" Roof Rise)
Continued
Mobile Home RA-20 RIM Criteria Page 1 of 2 + 12110
2. The home must be underpinned, consisting of a brick curtain wall or have galvanized metal
sheeting,ABS or PBC plastic color skirting with interlocking edges, installed around the
perimeter of the home. Skirting shall be consistent in appearance, in good condition,
continuous, permanent,and unpierced except for ventilation and access.
3, The homes moving apparatus must be removed, underpinned,or landscaped. (See examples
below.)
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4. The home must have been constructed after July 1S`1976.
(------.72?) 4...)71, (314- .-, j ii- 7-//
Signature of Property Owner/Agent Date
• By signing this form the owner/agent is stating that they have read and understand the
information on this form.
Mobile Home RA-20 RIM Criteria Page 2 of 2 12/10
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Grover Dale Ellis Jr.
17163 NC 27W
Sanford NC 27332
(919) 499-9900 Home
(919) 770-0015 Cell
I Grover Dale Ellis Jr. owner of property at 17031 NC 27W,
Sanford NC 27332. Give permission to Grover Dale Ellis III, to
place a home at this property.
Grover Dale Ellis III, is to place a home at above
mentioned address 17031 NC 27W, Sanford NC 27332 without
fees and or rental fees.
Sincerely
i>/
Grove—1 lis Jr. Date