LAND USE Initial Application Date: 1 Z' / Application # /° O � 7 (�
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 - 75255,�,. Fax: (910) 893 -2793 www.hametLorg /permits
LANDOWNER: D F R A" _ Mailing Address: W/. ke' %T C L.GY2sto /i& & sr
City: _ wl.V State/VC Zip.Jfl3 Contact # KNI.v Email: ,_,, f.y olau(.Ah „
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APPLICANT•: .99,va•rG•.ce' /Aa ma' Oj,., s.. ,f Mailing Address:
City: " 2 > 4 - m a , State:, C- Zip: 1 Contact # 1-- Email: L a/ - � e)a <r.� O s'�
'Please fill out applicant information if different than landowner j_, bill (3eA U..
CONTACT NAME APPLYING IN OFFICE: sP &o..? A -47 Phone # 9/ 9' 3 8 / - 9/, cr
PROPERTY LOCATION: Subdivision: C0 �sr -rnt Lot #: / Lot Size; . 9 C - C-
State Road vi1 State Road Name: / I /�U, /f`,�' -/ a _ /� Map Book &Page: 70�`9 I 73 *
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Parcel: ✓ / / 941'3 &' I/ (/ ! PIN: ! � .1 _ 7 _ i —�7 7 »'r az
Zoning: 1 ° �f
Flood Zone: Watershed: 1&__ Deed Book &Page: 75 2 5 / Ni 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: 7 t1r /fwry 2 7 Fro^^ L.'l agar-.
Crier oo-n, b4-9 29 *oar. 3 .�.% c m-*'o /T' f - r c•• fo n•• et"/ r .a.
PROF osED r , S ty —
d \ / CC / u r- O Monolithic
SFD: (Size5 � /� ) # Bedrooms:3 # Baths: 7 � Basement(w/wo bath): 1' �p Garage: ! GS Deck: Crawl Space: Slab: ✓ SIab:1,---
(Is the bonus room finished? ( ) yes ( )no 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? ( ) yes (_)no Any other site built additions? ( yes (
❑ 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 /Accesso ther: (Size x ) Use: Closets in addition? (__) yes ( )no
Water Supply: Co 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
Does owner of this tract of land, own and that contains a ma ufacture home within five hundred feet (500') of tract listed above? ( ) yes no
Structures (existing or proposed): Single family dwellings:rMA,a?i Manufactured Homes: Other (specify):
Required Residential Property 1
perty Line Setbacks: C66
Front Minimum _ _ Actual �
Rear 2 4 70,7
Closest Side /a 111
�
SidestreeUcorner lot
Nearest Building
on same lot
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.
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Signature offer 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
Residential Land Use Application Page 1 of 1 07/10
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NAME: 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 0 AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. The permit is valid for either 60 months or without expiration
ependi 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 {4(1 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 {r} NO Does the site contain any Jurisdictional Wetlands?
{_)YES {I) NO Do you plan to have an irrieation system now or in the future?
{_)YES NO NO Does or will the building contain any dimes? Please explain.
(_{ (441 NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
{_)YES {L,} NO Is any wastewater going to be generated on the site other than domestic sewage?
{_)YES {(,) NO Is the site subject to approval by any other Public Agency?
1 _)YES {) NO Are there any easements or Right of Ways on this property?
{ ` )YES {_) 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. fi
PROPERTY OWNERS OR OW LEG REPRESENTATIVE SIGNATURE (REQUIRED) DATE
5/08
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1 1101111111
200700006
0,..—) K6a5 `F 6. on 6yR[ cv DEEDS
lii F R ES SO
HARNETT COUNTY TAX IDJi g p 0Z 949 FEE:314.00 F:04 PA
BK1323 PG:90 &949
D�B� FOR NC REY I IN T , i
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en, BY //
NORTII CAROL HARNE.TT CO
THIS DEED, • • . 4 $. ,, y of January, 2007, by and between LILLIE ROSE IIOWERTON COOPER,
(widow), whose a. • ' - W - • Drive, Lexington, SC 29073, hereinafter calkxl the Grantor, and U&R
DEVELOPMENTS, , 'C I' ted liability company, whose address is of 804 W. Broad Street, Dunn, NC 28334,
hereinafter called the ee.
WI'1'NESSHIIl: • e It . r, n cnnsi ration of $100.00 and other valuable considerations to her paid by the
Cnantee, the receipt of which s h by ac c owl -• has bargained and sold, and by these presents does bargain, sell and
convey unto the Crrantee, its s cc ! a •se lands lying and being in Johnsonville Township, IIamed County,
North Carolina, and more parti !arty .es . ollows:
CONTAINING 66 acres, • • i 'ng all of Tract No. 4 on Mop Showing Land Owned by S.G.
Howell recorded in Map B.. I: • ett County Registry. See also deed to Otis Leland Cooper, Jr.
and wife. Lillie Rose Iiuwerto• Coo c te. Derev.er 10, 1963 and recorded in Bunk 427, Page 272,
Ilamen County Registry. for n . es Sound i
'1'O RAVE AND TO HOLD the of . . • all privileges and appurtenances thereunto belonging to the said
Grantee, its successors and assigns, forever. r
And the said Grantor, for herself, her he e:.r executors a • . adm • istmtors, covenants with the Grantee, its successors
and assigns, that she is seized of said premises in fee and has ' righ to c. vey the name in fee simple; that the same are free
from encumbrances except as herein set forth; and that she • 11W, - . and . efend the said title to the same against the claims
of all persons whomsoever. Title is conveyed subject • • . eco;., if any, and to 2007 taxes.
IN TESTIMONY WHEREOF, the Grantor has • creu • set - and and seal, the day nddye first above written.
.� -_'�Ar . . Lean. — _V5.,t Y
1.TI_L''ERTGN COOPER
ig
NORTH CAROLINA
HARNETT COUNTY ' y�
1, t) /7 L Pees , a Notar Public in and fo • con. county, do hereby certify that Lillie
Rose Howsnon Cooper, either being personally known to me or proven by sac' - fac ' e f. Ice (said evidence being __,
), personally appeared before me this day and se. owl: tag•: the • e execution of the foregoing
Deed for the purposes [herein expressed.
nA
WITNESS my hand and Notarial Seal, this the day of January , .1'
4Y 43,,
NOTARY$ " ' V b.
My Commission Expires; J D —/ O /0 1 ; rnr -
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PREPARED BY JOHN W. DEFS, ATTORNEY, GOLDSBORO, N. Iv
S ll aw Hrm DalloReal Es atAIW'DY)mtn; a• elcat Develam,mab( m +a, Hen,elt Coun:y'Oted.doc
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