LAND USE RRR z{zl(xo
Application # /37 •2. (2-, 41
Harnett County Central Permitting ���' 1111
PO Box 65 Lillington, NC 27546 9.7 /0
Telephone Number 910- 893 -4759 5t.5ybn 8/76-1
Application for Environmental Health Improvement Permit in Areas Zoned by Municipalities
Land Owner Information: ( � Applicant Information:
Name: Name: `r,-acr L. -sr
Address: too0 Lurr sea. Address: °)0 5 rJo-r ;Ls'tc(4y
r)( a ct -Aki Lkat Moor, Rd. e--5
Phone: Phone:(g1RSBisA -ns $ ( C-
Property Location:
E911 Address: (.) c3 " -an\; Ron d . �'+�;n �$ 9
PIN or Parcel Number: 15OCo- (0.5' (1
-I )5, U3T ( jcarc€ 1 CDW1-5 -O tp (>01 O
Subdivision: n to Lot Number n t rz
State Road Number tro:t w Lot Size: S .Le s act- e `�
Specific Directions to Job from Liilington: "Tclke ( t4.a l .Qrpt..,_L; (\; .- +s_-tt
j bin& $e( id, in Frt. - t} - ur 0 ri cam.. kit-a - i -an c le- f-F-on HL V
^ , ; , 5 5 l-eC-t- M \-1csr.; I + m . . C d i cvunar'F'. ,. r t \ 3 CA - 43"5v Ran n . r road.
Proposed Use: 90 21% 4
/�Ltd ? !
( ") Slagle Famelling (Size: x (
ily nw ) # of Bedrooms: 3
Basement: Basement w/ Plumbing: Deck:
( ) Multi Family Dwelling # of Units: # of Bedrooms/Units:
( ) Manufactured Home (Size: x ) # of Bedrooms:
Garage: Deck: -2..' � sec -� ai� CE VV101 )t.
(v( Number of Persons per Household 3 e,- `Cct'` & . 6 04—
( ) Business Square Footage Retail Space: Type: t ii-,c et.--Vain 0-
ai ( ) Industry Square Footage: Type: �'rn9 h"ed
CutaLSlQflt .—
( ) Home Occupation # of Rooms: Use: 612.&._a_11
( ) Addition to Existing Building Size: Use:
( ) Other:
tia- Water Supply: ( ) C unty (ell ( ) Other
Sewer: (w Septic Tank ( ) Existing Septic Tank ( ) Revision ( ) Sewer
Applicant Signature: t! sartil■ li . a .0-.9-- Date: ll-LBojo'5
08/04
County cerhts i'lul the -lap or;,Opt I_ Y■ his ceriitii
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MINIMUM REGUIREMEh I
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• DEPARTMENT OF TRANSPORTATION Fen a Line
DIVISION OF HIGHWAYS \
NO APPROVAL NECESSARY F n I R/W x 1
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DISTRICT ENGINEER u' •
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NORTH' CAROLWA - x x "'xe
HARNETT COUNTY ..
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This Mop /Plat was presented for r yis':ralfen and recareed ?\` \ 20' - \ . \
in this office pi Mop e Namhei. 9. �\
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o'clock M nnw.vc 111 x
NAME: APPLICATION #: 1629 #137 VgIff
*This application to be tilled 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 1S 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
epending upon documentation submitted. (Complete site plan = 60 months; Complete plat = without expiration) 111 Q 2 /
- 910 -893 -7525 option 1 CONFIRMATION# d ,/
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 trlp 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.
❑ 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 applying for authorization to construct please indicate d sired system type(s): can be ranked in order of preference, must choose one.
I_) Accepted {_) Innovative I ) Conventional I —) Any
I - 1 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:
I_) YES {SI NO Does the site contain any Jurisdictional Wetlands?
{_)YES {',) NO Do you plan to have an irrieation system now or in the future?
{_)YES I ) NO Does or will the building contain any ? Please explain.
I4IYES I I NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
I_) YES 1 I NO Is any wastewater going to be generated on the site other than domestic sewage?
I_)YES ( ) NO Is the site subject to approval by any other Public Agency?
(OYES I_) NO Are there any easements or Right of Ways on this property?
{][IYES 1_) 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 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.
PROPER N ERS W R S LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) ATE
11/09
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Certified to • . • tro_daya. ,
by v-
asi TNs Matmme was
4. .. .... 8 Yatleewrl PDLC, Lynn A. <AalUreera
pwfawreddY PtePeK)
&tot Daetriplon b de 11, it • Wd6e Jatlm e Estate I
NO • v GENERAL WARRANTY DEED
THIS DEEDade , _.t ?
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GRANTOR GRANTEE
=HARD WADS JACKSON and wee. JACKSON
NIbODYN. JACKSON
and
THOMAS E. JACKSON, JR. urarwnbd
600 Lune Read
Duren. North Candela RUM Kea
Enter in @pprapdets black for each party: =tar, address, and character of retry, Lg.,
corpnreton r psnnraNp. �
The desI nSion Granbrald tirartbe =lead iii
ant" and dad Mlle era atr, plural, maaadhe, temMMa or - • , t : conked WITN SSETH, Nat the Gm te
ntar, for vabb oansleaaewt pad by - t a which r
herebyada.wlsdWd. Si and bytltess prwards dossvTwd. bar y ... z"T • erne= MM
simple, all that certain lot or parcel a Ind eltuebd M or NW n the C y & ar , Harnett
Cowry, North Careens end mars paA@WMydeeaibed as Saw
S= Unitta A attached hereto end made • pen hereof
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Application # /3
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910 - 893 -4759
Application for Environmental Health Improvement Permit in Areas Zoned by Municipalities
Land Owner Information: Applicant Information:
Name: ' L)Qd-e SQCk.,5c Name: - Tr a rnm L• tr"cl Pod
Address: (you u..tr».SQa. f Address: ')c 3 (-)cr-r t4
t Ail »P�- - 4�,?M 4cao Mann pa. emits
Phone: Phone:(giq)ltd), -ns $ (C-'
o 11•-a(
Property Location:
E911 Address: cD13 �) nVI Ik IR.d . ii Z J� - ■ .)+ ZW
PIN or Parcel Number 1'5L(- (os -1 t7J (X l rc Otol - 10Q) 05.31 U )
Subdivision: r\1O_ Lot Number: n1 n
State Road Number: \-v- %.n Lot Size: '43 ,LAS acr r `�
Specific Directions to Job from Lillin ton: - Tate i-{t-4 { t PrON - L - L, ( 1Z
i ir?r r -k in Vrt - 1 - tar ( r+ na. . } {t,.T "( _2. r7 le- 4 -i-o-, 1-R -
'ry) 5 1.42C nn r :j ( -I&tse Rcyr1 Ara r ead
Proposed Use: ` l/ C ,/ L ( /1
(') Angle Family nwelliag (Size: 1 4O x (oO ) # of Bedrooms: 3
Basement: Basement w/ Plumbing: Deck:
( ) Multi Family Dwelling # of Units: # of Bedrooms /Units:
( ) Manufactured Home (Size: x ) # of Bedrooms:
Garage: Deck: ,�oLhcim he o 1e
�- 1 l,
(✓( Number of Persons per Household 3 C.I c c .
( Business Square Footage Retail Space: Type:
( ) Industry Square Footage: Type:
( ) Home Occupation # of Rooms: Use:
( ) Addition to Existing Building Size: Use:
( ) Other:
Water Supply: ( ) C - unty ('ell ( ) Other
Sewer: (w Septic Tank ( ) Existing Septic Tank ( ) Revision ( ) Sewer
Applicant Signature: et, a►rb S - a a o Date: (340
08/04
Application Number: 0 5 506(3 7S3
Harnett County Planning Department
PO Box 65, Lillington, NC 27546
910 - 893 -7527
- Environmental Health New Septic S est
Environmental Health Code 800
• Place "property flags' in each - • lot. All property lines must be clearly flagged.
• Place "house corner flags" at each corner of where the house /manufactured home will sit. Use additional flagging to
outline driveways, garages, decks, out buildings, swimming pools, etc.
• Place flags at locations as developed on site plan by Customer Service Technician and you.
• Place Environmental Health "orange" card in location that is easily viewed from road.
• No grading of property should be done. Undergrowth should be clean - • .1..,.0 allow soil evaluation to be performed.
Inspectors should be able to walk freely.
• After preparing pro osed site call the voice permitting system - 10- 893 -752 and give code 800 for Environmental
Health confirmatio lease nnte nnnfirmatinn rjher niven at and n r• . - ina for proof of request*
• To hear results, ca IVR in approx.7 -10 working days. Once approved, proceed to Central Permitting for permits.
Environmental Health Existing Tank Inspections
Environmental Health Code 800
• Place Environmental Health "orange" card in location that is easily viewed from road.
• 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 -7527 and give code 800 for Environmental Health
confirmation. Please note confirmation number given at end of recording for proof of request.
• To hear results, call IVR in approx. 7 -10 working days. Once approved, proceed to Central Permitting for permits.
_ Health and Sanitation Inspections
Health and Sanitation Plan Review 826
• After submitting plans for food and lodging, call the voice permitting system at 910- 893 -7527 and give code 826 for
Health and Sanitation confirmation. Please note confirmation number given at end of recording for proof of request.
• To hear results, call IVR in approx. 7 -10 working days. Once approved, proceed to Central Permitting for permits.
_ Fire Marshal Inspections
Fire Marshall Plan Review Code 804
• Call the voice permitting system at 910 -893 -7527 and give code 804 for plan review. Please note confirmation number
given at end of recording for proof of request.
• To hear results. call IVR in approx 7 -10 working days. Once approved, proceed to Central Permitting for permits.
• Pick up Fire Marshal's letter and place on job site until work is completed.
: Public Utilities
• Place stake with "orange" tape /name thirty feet (30) from the center of the road at the location you wish to have water
tap installed.
• Allow four to six weeks after application for water /sewer taps. Call Utilities at 893 -7575 for technical assistance.
-:-; Building Inspections '
• Call the voice permitting system at 910 -893 -7527 to schedule inspections. Please note confirmation number given at
end of recording for proof of request.
• For new housing/set up permits must meet E 911 / Addressing guidelines prior to calling for final inspection.
• To hear results of inspections, call IVR after scheduled inspection is done.
E911 Addressing
Addressing Confirmation Code 814
• Address numbers shall be mounted on the house, 3 inches high (5" for commercial).
• Numbers must be a contrasting color from house, must be clearly visible night and day at entrance of driveway if home
is 100 ft or more from road, or if mailbox is on opposite side of road.
• Once you purchase permits and footing inspection has been approved call the voice permitting system at 910 - 893 -7527
and give code 814 for address confirmation. This must be called in even if you have contacted E911 for verbal
confirmation.
Customers can view all � Inspection results online at www.harnett.orq.
Applicant Signature: �'�PJ�"� -- . �O Date: la -W(D
03/05