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LAND USE Initial Application Date: 9 — ,3 — //(/ Application # /P 5'r/ 254 COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION Central Permitting 108 E. Front Street, Lillington, NC 27548 Phone: (910) 893-7525 Fax: Al Fax: (910 ) wv/w.hamett.org/permits ww.hamett.org/pemtits LANDOWNER: y j )_ c{ f �, r-� ''..``11 Mailing Address: ic 111 C. S S W City: <.nn� state: NC Zip: .73�.n Contact # N 1-0:1C19 Email: rA . _ r, T n' a Crl APPLICANT': 4 Mailing Address: City: State: Zip: Contact # Email: 'Please fill out applicant information if different than landowner {� CONTACT NAME APPLYING IN OFFICE: bnt l 11 RC1') Phone # l PROPERTY LOCATION: Subdivision: /� /� Lot #: / Lot Size: f / State Road # ,fj / State Road Name: � L e: /� 6 27E_ q c� / Map Book&Page: / Parcel: 97 (/ 6 92 0 /4 ✓ '-y PIN: A'' — 7, 742, cam Zoning: / 1 2 A ' ( /� Flood Zone: Watershed: — F - l � — Deed Book /Page: / / [ a Power Company *: / zz 'New structures with Progress Energy as service provider need to supply premise number .. from Progress Energy. SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: - 1 - 411-?,. a-) ( 3 at 04 1 e , 45 c-r Nt 4'A wsack Cdr ec T/ R an oirj Al •bece - kiNt -Wooing kfAle(S so AVet43 9 ci, c!'Mot'3' fit e eile klyt kind ;i an Legit 'sr.nr) S;de. RO SED USE: L SFD: (Sizel �� x 1 '11 ) # Bedrooms: # Baths. Basement(w/wo bath): Garage: Deck: 1 Crawl Space: t Slab: Stab: hl Monolithic (Is the bonus room finished? ( ) yes ()( )no w/ a closet? (J yes ()Ono (if yes add in with # bedrooms) ❑ Mod: (Size x ) # Bedrooms # Baths Basement (w/wo bath) Garage: Site Built Deck: On Frame OR Frame (Is the second floor finished? (._) yes (__)no Any other site built additions? (__) yes (ono ❑ 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/Accessory/Other: (Size _ x 1 Use: Closets in addition? (J yes (__)no Water Supply: _ County _ Existing Well '\ New Well (# of dwellings using wed ) *MUST have operable water before final Sewage Supply: X New Septic Tank (Complete Checkdlsl) _ Existing Septic Tank (Complete Checklist) _ County Sewer Does owner of this tract of I, own land that contains a manufa red home within five hundred feet (500') of tract listed above? (J yes no Structures (existing or �� Single family dwellings: Manufactured Homes: Other (specfy): Required Reeldentla ' / ropertyy Line Setbac : Comments: Front Minimum ✓`� Actual / Rear it, G �J o Closest Side /O /7 Sidestreeticomer 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 ccurate and correct to the best of my knowledge. Pemlit subject to revocation if false information is provided. 310 a of 9-'3,- all lo 5l alure of r• 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 § ,� o It p .rte 5 6' _o J NI ' ° f 4 '� d ' I Oh � 4 ; 'db'oh`�f a+ a �,t � '✓�S" 0l ° -to tim '• 4. x 4 . " " >�, w '�'ir yr •D, rt k: ' f i to, 1 fi L R by" �' ✓ tDD97a 5 4* O C f. i y y s, ' 4 ? '11, J v ' 0� 9 i ty r K 2 t a " IU,W p m I 33 y -0 . M ;A co `D aV;r i - ' x A •`,- O r . . x T " * x ' ' , i i i h �, "'r i UV r ' 7�.F X a� t # � � 9 t t4^ a Jlak "' \ D i e n 31,1 p, p I wH q of 1 D t f P �1 t uf f ( . `7 L� � , ,• M N 9 / � a tt5r b � x ! "'Tt � , I WWW/ os N r r v , " yp � � 9� � ` O n ' o a . i is 3*� r ' Q• N` I I J , ` Ts U , i' 0 y r 1. 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' u , r t a 4 ' i 'f ` n , : , „ = a = = r ,, 0 , - ir y✓ • I ` � }-4 1 '•" y {� � '� � ' ,b 1 " r 4014.6 "'N v1 Y .xii 4'.v. ��, .+ ,= i 4 �' � 5 i'ffc.: t ' , q Y t p e g p ` , x ti r i , v , �," r , ^C'� ' V ,- n Y t i� r i, '' ' yt�. " -4 1 i M1 • ix \ rw..$'., �,y' r'��� 7 I r a q f fl �+ � 1 NAME: APPLICATION #: /0 CO 0 2- c j *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 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 aiven 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 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 aiven 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 {_J Innovative {(X Conventional {_) Any {_ J 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 {X) NO Does the site contain any Jurisdictional Wetlands? {_IYES b41 NO Do you plan to have an irtisation system now or in the future? {_)YES { } NO Does or will the building contain any drains? Please explain. I — IYES Oki NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property? { _ }YES J) NO Is any wastewater going to be generated on the site other than domestic sewage? {_DYES 1 NO Is the site subject to approval by any other Public Agency? {_ }YES { )() NO Are there any easements or Right of Ways on this property? (_)YES {)4J 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. "� C *10 PROPERTY OO -'B ERS 0 0 E S LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE 11/09 Harnett County Department of Public Health Well Construction Permit Application If the information in the application for a Well Construction Permit is falsified, changed, or the site is altered, then the Well Construction Permit shall become invalid. APPLICANT INFORMATION t v \ • ) 4.1 t Applicaht/Owner Phone Number W C �G Lj CaQ / Me a Street Address, City, State, Zip Code The Applicant must submit a Site Plan. The Site Plan is a map /drawing of the property and must show: I. existing and/or proposed property lines and easements with dimensions; 2. the location of the facility and appurtenance; 3. the location for the proposed well; 4. the location of existing or proposed sewer lines and/or sewage disposal systems within 100 feet or the proposed well; 5. the location of any existing wells within 100 feet of the property; surface water bodies; 6. above ground and /or underground storage tanks; 7. and any other known sources of contamination within 100 feet of the proposed well site. The Applicant shall notify, the Harnett County Health Director through or by way of the Harnett County Division of Environmental Health if any of the following occur prior to well construction: 1. there is a relocation of the proposed facility; 2. there is a change in the intended use of the facility; 3. there is a need for installing the waste water system in an area other than indicated on the well permit; or 4. there are landscape changed that affect site drainage. Contact information: Environmental Health Division - 910 - 893 -7547 PROPERTY INFORMATION Proposed use of well Single - Family MultifamilyD Church 3 Restaurant 3 Business Irrigation J Street Address Subdivision/Lot # O Parcel �� O1, 92 e/4 PIN# 05 - 29— 746 Directions to the Site TO'S' • • 0- 1--`, 11 ' n • A • - te, ► s L Qi • a • , 1 have thoroughly read and completed this Application and certify that the information provided herein is true, complete and correct to the best of my knowledge and is give In good faith. Representatives of the Harnett County Health Department and state omciais are granted right of entry to conduct necessary inspections to determine compliance with applicable rules. / understand that / am solely responsible far the proper Identification and labeling of all property lines, underground utility lines, and making the site accessible so that a will can be properly constructed according to the permit Property Owner of Owner's Leg' I Representative Signature Required Date How to Properly Mark Property for Soil Evaluation (MUST MATCH SITE PLAN) 'ink flag c iron pink flag —► . orange flag 4-- ink flag isa Legend House flag range flag pink flag iron f ,?; iron ROAD 11111111111 1111111111111111 2030031702 { HA ETT COUNTY TAX ID# W1). arto FOR REG/STRRTION REOI6TER OF °"" HAR COUNTTYY ncE 8K: PPUG 755 - FEE: $22, 00 INSTRUMENT # 1010011702 NORTH CAROLINA GENERAL WA o 0o RRANTY DEEDS . ,� t -4`' Excise Tax: ; Parcel Identifier No. Verified by County: n the . da of . - is '` 0 `�" BY: ty. Y` 30 '3 � Grantees MaillBox to: This instrument was prepared by: Ray McLean — , Attorney (deed prep only) Brief description for the Index: THIS DEED made this 16th Au t day of $ � , 20 , by and between GRANTOR GRANTEE Milton Ray Roberts and wife, Daryll Scott Roberts and wife, Nancy Stout Roberts Marina Roberts 1E466 NC 55W // NC 27521 Enter in appropriate block for each party: name, address, and, if appropriate, character of entity, e.g. corporation or partnership.. The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include singular, plural, masculine, feminine or neuter as required by context, WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has and by these presents does grant, bargain, sell and con v iil`a tt th > re t�c ee in fee simple, all that certain lot or parcel of land situated in the City of , e me Township, Harnett County, North Carolina and more particularly described as follows: Being all of lot #1 containing .95 total acres with a 50ft ingress, egress and public utilities easement as shown on map # #2010 -588 of the Harnett County Registry. The property hereinabove described was acquired by Grantor by instrument recorded in Book page A map showing the above described property is recorded in Plat Book page " NC Bar Association Form No. 3 © 1976, Revised © 1977, 2002 + James Williams & Co., Inc. Printed by Agreement with the NC Bar Association - 1981 www.JamesWilliams.com