LAND USE Initial Application Date: f - �� Application # 7 7 1.2 2 5 62,b-
CU#
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.org /permits
LAND / �OWNER;Jf n d ten. 'y/�rc -r:.J Mailing Address: AGO .G :- .22/
City:�/,o4 State: Zip:2754aontact #379- 8 Email: i'_,dg,s #rI4 `md,Ca,c._
APPLICANT*: T/Ltm E./,"„ -A' M c--cx Mailing Address:° at .23/
City: Stater 'f
Zip: -226 Contact # Email:
*Please ill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: Phone #
PROPERTY LO CATION: Subdivision: /24u / L(/
T Ai44 .op L( t Lot #: Lot Size: i.• ' 0
/
State Road # i State Road Name: L9 / q1.', : / ? / / / 4 — Map Book &Page: Gp�(�/ p Parcel: //Flood 4 0 // �' r • J 7 ( PIN: 9 (T _ / ' — a 'a,
•
Zoning: l ? /Flood Zone: �� Watershed: Deed Book&Page: 27 7 Z1 `//�', LLY 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: C0. al-,47' a... ARff ye"-, /?CL / .rNi/c eK
PROPOSED USE:
X 52 1 .3 / ` — Monolithic
/ W, SFD: (Size �7T x ) # Bedrooms: # Baths:' t yes bath): v _ Garage: Deck: Crawl Space: / Slab: Slab:
(Is the bonus room finished? t yes ( _Jno w/ a closet? (_J 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? (J yes (__)no
❑ Manufactured Horne: SW _DW TW (Size x ) # Bedrooms: _ Garage: (site built? ) Deck: (site built? )
❑ Duplex: (Size _x ) No. Buildings: No. Bedrooms Per Unit:
❑ Horne Occupation: # Rooms: Use: Hours of Operation: #Employees:
❑ Addition /Accessory/Other: (Size x ) Use: Closets in addition? ( ) yes (__)no
Water Supply: X 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 (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 (Zino
Structures (existing or proposed): Single family dwellings: Manufactured Homes: Other (specify):
Required Residential Property Line Setbacks: Comments:
7 i
Front Minimum 7 7 Actual 7/
//
Rear L7 ///7
/
Closest Side .29±.5.4
Sidestreet/corner 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 an• orrect to the best of my knowledge. Permit subject to revocation if false information is provided.
_ •r.'�4,1••••••- c /ee - /63
Signature of Owner 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
LEGEND
CFMLYBEATE SPRINGS RD MS NOT TO SCALE
EIP EXISDNG IRON PIPE
PP POWER POLE
O V/11,1 WATER METER
R TB TELEPHONE BOX G
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OHPL OVERHEAD POWER UNE V�`, 9�
F. - FLARED END C (PIPE) Q N"
RCP REINFORCED COONC. . PI PIPE
B.O.C. ROCK OF CURB / ��F ••
41 1T, F.H. FIRE HYDRANT
C \0 SEWER CLEW OUT
DS EXISTING RON STARE
M.H. MANHOLE
VICINITY YAP (NTS) ECM EXISTING CONCRETE MONUMENT
P.N. PARKER KALON NAIL
HARNETT COUNTY
BOARD OF EDUCATION
M.B.2003, PG.767 I
D.B.1936, PG.761
N 25'14'30 "E 168.88'
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LAFAYETTE ROAD
(eo• AIBLIC R/1►)
NOTE: SHOWN IS LOT 2 OF •
TIMOTHY J. MANGUM S/D
REF: B.O.M.2006 PG.81
50 0 50 100 150 am
AREA = 0.911 ACRES (GROSS) • • • • • • • • • •
•••■•••■
XXX LAFAYETTE ROAD GRAPHIC SCALE - FEET
7145 IS TO CERTIFY THAT 1145 WP S PRELIMINARY PLOT PLAN FOR:
PREPARED FROM AM ACTUAL WRVEY OF THE MATTHEWS CONSTRUCTION
PREMISES, WDE UMIR MY s�ENASION, No
THAT THERE Nt NOT ANY ENCROACHMENTS,
=PT AS NOTED TO THE BEST OF MY KNOWLEDGE.
1FNT THE RATIO OF PRECISION AS CALCULATED BY
IATIIINES AND DEPNRURES IS 1:10,000. HECTOR'S CREEK TWSP., HARNETT CO.. N.C.
11 5 MN' WAS PREPARED FOR FOR TIRE COMPANY USE SCALE 1" = 50' AUGUST 10, 2010
AND IS NOT WENDED FOR RECORMID4 OR
COINEYNI FS MR OUT MTVREN NI IOVZAIUN MAULDIN - NATIORS SURVEYING, PA.
OF THE SURYEIOR MD OTTER APPROPRIATE OFRCNLS. I P.O. BOX 444 / 1301 W. BROAD ST.
PROFESSIONAL WID SURVEYOR PRELIMINARY PLAT FUQUAY YARINA, NORTH CAROLINA 27528
NOT FOR RECORDATION
L - 3247 (919) 552 -9328 3152 -
NAME: APPLICATION #: 5 ZcG
*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)
/tc Environmental Health New Septic Systems Test 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 structure site. Use additional flags to outline driveways,
garages, decks, out buildings, swimming pools, etc. Place flags per site plan developed at/for Central Permitting.
• Place Environmental Health "orange" card in location that is easily viewed from road.
• 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 and use code 800 (after selecting
notification permit if multiple permits) for Environmental Health confirmation. 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 permits.
❑ Environmental Health Existing Tank Inspections Code 800
• Place Environmental Health "orange" card in location that is easily viewed from road. Follow above instructions
for placing flags 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 & select notification permit if multiple
permits, then use code 800 for Environmental Health confirmation. 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 {A} NO Do you plan to have an irrig s ystem now or in the future?
{_ }YES (-A} NO Does or will the building contain any drains? Please explain.
{}YES f.} 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 {r} NO Is the site subject to approval by any other Public Agency?
{ }YES {-E} NO Are there any easements or Right of Ways on this property?
{ }YES {K} 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.
I Understand That I Ain 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.
rd
PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
4/08
How to Properly Mark Property for Soil Evaluation
(MUST MATCH SITE PLAN)
•
ink flag
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iron
pink flag —1' orange flag
1 i 4 ' ink flag
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rgend House
flat iro>i"
range flag
pink flag
iron (;
c• iron
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