LAND USE •
Initial Application Date: 9 /57/ Application* 49 9 Pg7 Z fizit
DRB # CU #
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
..rWCentral Permitting 108 / E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.harnett.org /permits
.•..LANDOWNER:e�i Q.lz�Q24.e.7.: / n t
/t ng Address: . Sr' c * _
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APPLICANT': OqC? . T c, „ M $ 0 N Mailing Address: $(3 - 1 / t i••
_ City: '2, /.(JA StateAf( zip: (9 VRLsontact# /9/ 9 • 914 •t''y.2� Email:
'Please fill o t pplicant info ation if different than I downer /}
CONTACT NAME APPLYING IN OFFICE: . ((r'rj',- ✓ #'4 12 At / Phone # 9' (9 -. 9 211 -r / v 2
PROPERTY LOCATION: Subdivision: , ��L .� A/1 ( L n0. • - es ,i n�.ep[ /OR ,Lot #: Lot Size: ( 0 1p )
••?; Slate Road )# / lit 2. 9 2. State Road Name: ( n 1. 1Ai o ,. - ../., ar(r..dt, ,,/p Map Book &Page: [ .9 / i P/�`p
Parcel:: 1/ i O(i, / 5 ' ✓ 012F v PIN: ✓ L C3 ` 47
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Zoning:et ?' Flood Zone: Watersh _ T Dee Book &Page: 1' 17 / 9/ Power Company':hn
*New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: cam .) k 4 1 Q( f7 rr "+ 7 en' " 1i,iso kitg
Fd �o�✓y avg.. A.,.2, CAS dvid..WO114 34 ,.,,,i.. ; :.t, t4,. .4 . ry , ,i7/
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PROPOSED USE:
❑ Multi - Family Dwelling No. Units: No. Bedrooms/Unit:
❑ Business Sq. Ft. Retail Space: Type: # Employees: Hours of Operation:
❑ Daycare # Preschoolers: # Afterschoolers: # Employees: Hours of Operation:
❑ Industry Sq. Ft: Type: # Employees: Hours of Operation:
❑ Church Seating Capacity: # Bathrooms: Kitchen: !'•
41 Accessory/Addition /Other (Size /f x.1)) Use: 19 • ' q t €.,
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Water Supply: 7 Existing Well New Well ( (# #�f dwellings using well ) *MUST have operable water before final
Sewage Supply: New Septic Tank (Complete Checklist) J 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 statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
/s, ' 5; -
Signature of ner or Ow • : is Agent Date
**This application expires 6 months from the initial date If permits have not been Issued**
grl ECORDED SURVEY,; MAF -RECORDED_ DEED'(OR OFFERi70P,_UROHAiEifND PLAT AREREOUIRED WHEN APPLYINGFORL'AND USE APPLICATIONI
Commercial Land Use Application Page 1 of 1 03/10
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NAME: APPLICATION #: /1 9 PD z4 10
*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, CHANCED, 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) //; /, o
910- 893 -7525 option I CONFIRMATION W ,% dV
❑ Environmental Health New Septic SvstemCode 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 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.
,,c 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 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 as > lying for authorization to construct please indicate desired system type(s): can be ranked in order of preference, must choose one.
) • - rted {_} Innovative ( —) Conventional (_) Any
{_} Altemativ {) Other
The applicant shall nott the local health department upon submittal of this application if any of t• ollowing apply to the property in
question. If the answer is " - ", applicant MUST ATTACH SUPPORTING DOCUMENT: ' ION:
(_)YES {_)NO Does the sit- sntain any Jurisdictional Wetlands?
{_)YES (_) NO Do you plan to have .1 'Ili! . .11 - n now or in future?
(_)YES {_) NO Does or will the building co .in any • .'t� ` ease explain.
(}YES I_ NO Are there any existing wells, sprin_ •aterlines or Wastewater Systems on this property?
{_}YES {_} NO Is any wastewater going to be _ - nerated • he site other than domestic sewage?
(_)YES (_) NO Is the site subject to a! : oval by any other Publi • _ency?
(_)YES (_) NO Are there an - . ements or Right of Ways on this pro rty?
{_IYES (_) 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.
1 Understand That 1 Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The SiteA cessible So That A mpl. a Site Evaluation Can Be Performed.
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PROPER f OWNER • R OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
11 /09
DIAGRAM OF A TYPIC EPTI ANK
POSSIBLE POSSIBLE
HOUSE HOUSE
CONNECTION CONNECTION
POSSIBLE
HOUSE
CONNECTION
POSSIBLE LID SHAPES
SQUARE (SHOWN ON DIAGRAM)
RECTANGLE (OLDER TANKS) (1) ROUND