LAND USE Initial Application Date: 7-- 7 /i "- /O Application # 0 r . t9 z4 y /
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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.orglpermits
LANDOWNER: OW LII r Jef l71'� ) Mailing Address: 35) i / b c71.'f 1.--.61 City: PtYIG3lt.'.v State: uC - zipZ750( Contact #E1ID) ¶q7 -S 72fj Email: I
APPLICANT*: II JI e— 45 ( YI. C� � to ✓L . t 5 Mailing Address: 57p Dei 1 t 1 k bo1'7) I � S -- k -, '
Cit ?5 l ' , , ) Stat ZipZ Ad
Contact# � Email:
'Please fill out appli nl information if different than Ian d
CONTACT NAME APPLYING IN OFFICE: k Yz &2A C /' m a_d_boe Phone # �J D5Z -g7007 x 23/
PROPERTY LOCATION: Subdivision: 1 n r1 in / Lot #: Lot Size: 2 • / 1� ZQ�r{
State Road � #/ 4 2- State Roo /A ad Name: .1 I� /.� J /} Map Bo�okk &Page:E C! r/ Z. - d o
P /
Parcel: �7 / b 0 / _ c047. - . � / /f PIN: / / ( ( - 7 y j��/ ✓/0
Zoning: ft/ 30 Flood Zone:, , Watershed: �U /% Deed Book&Page: /C g A / 7 0Z- Power Company ":
'New structures with Progress Energy as service provider need to supply premise number p ,/J from Progress Energy.
• P CI :IC r - E TI • 0 • E - - • . ' ; • ' I • ON: //,(� ETA / ✓,%1
PROPOSED USE:
Monolithic
❑ SFD: (Size x ) # Bedrooms:_ # Baths:_ Basement(wlwo bath):_ Garage:_ Dedc:_ Crawl Space:_ Slab:_ Slab:_
(Is the bonus room finished? ( ) yes Lino w/ a closet? (_) 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? (.J yes ( )no Any other site built additions? ( ) 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:
X Addition /Access /Other: (Size 111 x 3$ ) Use: '[t(^ Loy\ (L C rs n 0 1 Closets in addition? ( ) yes ( )no
Water Supply: County Existing Well New Well flings 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? ( ) yes )no
Structures (existing or proposed): Single family dwellings: 1i, Manufactured Homes: / Other (specify): . -c 6//
Required Residential Property Line Setbac s : Comments:
Front Minimum 5 Actual 6(P 0
Rear L r t
Closest Side M 2 0
Sidestreeticorner lot
Nearest Building
on same lot
If permits are grant I agree t conform to ay or' antes and laws f'' he State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that regoing tements are a 'rate and correct t. 8 be of my knowledge. Permit subj to re O cation if false information is provided.
it J 710 / `a
Signature of Owner or Owner's Agent Da
'"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
Application #
i Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910- 893 -7525 Fax 910 - 893 -2793
Land Owner Information: Applicant Informati.n: I
Name: Da / i 1�i tr �r'Pgon' Name: ! 00
Address: 3515 R 4 -140(r R1 C-) Address: -+ : I te _ .
1 Ert i v^, Nkt 27501
Phone: ( /n) 5 J7-- -p' P hone: :Mitre _
Property Location:
E911 Address: ?6)5 1419a o it A
PIN or Parcel Number: (j,oZ- 31— $f53q / PArccab - 011601 00 O
Subdivision: Cu_yr "�itrli +on Lot Number: 1'-f
State Road Number: 1552 NC s& Do3Svs X Lot Size: 2• v2. ace
Specific Directions to Job from Lillington: N 1-121 S • o n 1 - e - 5 !
{7179-11 Av,t , lAgniC, XLI nmY 5 NL-77 n hae -n. 2 51- ew1..,,st 5 1- (NC -2..7G)
nn 1.1 Drrwl SL i _n mg'? Rho - }-a- r,iv lzd. S/
Proposed Use:
() Single Family Dwelling (Size: x ) # of Bedrooms:
Basement: Basement w/ Plumbing: Deck: Slab or Crawl Space
() Multi Family Dwelling # of Units: # of Bedrooms /Units:
() Manufactured Home (Size: x ) # of Bedrooms:
Garage: Deck:
() Number of Persons per Household
() Business Square Footage Retail Space: Type:
() Industry Square Footage: Type:
() Home Occupation # of Rooms: Use:
() Addition to Existing Building Size: Use:
($ Other YDk rt 'D. /ex .
Water Supply: ( ) County ( ) Well ( ) Other
Sewer: ( ) New Septic Tank ( ) Existing Septic Tank ( ) Revision ( ) Sewer
There is a $250.00 charge f• r this service. This approval is subject to revocation if the
intended use of the - eptic -ystem changes or if false ' nformation is provided on this
application. Your s'gnature below certifies it orma . above is correct.
Applicant Signature. _ 7/I7 ' Date: 7A3(/0
(( 10/06
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35 I S >I'll% r . I
i:e_r NC, 27 50 )
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SITE PLA APPBC)Vi. Litt; ,
DISTRICT
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*BEDROOMS
Zoning Adminis for
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NAME: APPLICATION #: /P 4 ^ 2 292
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*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
• 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. 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
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 {_} 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 itLigation System now or in the future?
I }YES ( NO Does or will the building contain any Sifaj ? Please explain.
{_IYES 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 I_} NO Is the site subject to approval by any other Public Agency?
{_)YES I_) NO Are there any easements or Right of Ways on this property?
{_}YES f _} 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 hat I Am Solely Responsible F Pr r Identification And Labeling Of All Property Lines And Corners And Making
TI$ Site Acc ssible So That A.Complete e Evaluati an Be Performed.
L (
PR E OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DA
5/08
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DIAGRAM OF A PICA SEPTI ANK
• UTLET LID
POSSIBLE POSSIBLE
HOUSE HOUSE
CONNECTION _ CONNECTION
POSSIBLE
HOUSE
CONNECTION
POSSIBLE LID SHAPES
SQUARE (SHOWN ON DIAGRAM)
ROUND
RECTANGLE (OLDER TANKS) _