LAND USE Initial Application Dale: q - ' _ f p Application # / S 2 C 2 3
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Genital Permitting 108 E. Front Street, Lllington, NC 27546 Phone: (910) 893-7525 Fax: (910) 893-2793 www.harnett.org
LANDOWNER: _ F. ��� _ /v 14,-- /- /
C / _Mailing Address: e2 �J "' ( 4/c aio 4I
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City: 1"fl91CY St r Zip: 7 Home k: [� � C l omact #:419 42R 7as
APPLICANT':_ ! ' 511fiaf !/L j Mailing Address: 6M1 I A�ou2
City: Stale: h p: Home #: Contact It
'Please fill out applicant into it diterenl Than r
CONTACT NAME APPLYING IN OFFICE: 1 � S l �(l Phone #: y 1 9 � 7 % t 5
PROPERTY LOCATION: C '.l{51 Map Subdivision: WF J VI (7T Lot #: 13 Lot Size: MO
State Road f #: d // t �� State Road Name: ' Map BookaPage: / 737
Parcel: _
0» 0(.5 q tr,__ PIN: (f525 -17 - S3. 000
,
Zoning: (4 7917 Flood Zone: Watershed: t Deed BookAPage: x917 / n
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILUNGTON:
)O Smith IO m;le5 Lek en qtr Rd. wALk 4ravA 65 ch Le
Circle:
PROPOSED USE: t ✓/
Ek SFD (Size y S x � la Bedrooms s, a
# Bath. Basemen (wAvo bath) _ Garage
Deck : / Slab
❑ Mod (Size x ) # Bedrooms it Baths Basement (wMc bath) _ Garage Site Built Deck ON Flame / OFF
❑ Duplex No. Builtings No. Bedrooms/Unit
❑ Manufactured Home: SW DW TW (Size _ x ) # Bedrooms _ Garage _ (site built? ) Deck (situ built? )
❑ Home Occupation #Rooms Use
Hours of Operation: #Employees
❑ AdditioNALCessorylOther (Size x Use
Closets in addition( (yes (_)no
Water Supply: yC) County (__) Well (No. dwellings ) MUST have operable water before final
Sewage Supply: (_) New Septic Tank (Complete Now Tank Checklist) Li Existing Septic Tank ( ) Cathy Sewer
Property owner al this tract of land own land that contains a manufactured home wain five hundred feet (500') of tract listed above? (DYES LINO
Structures (existing on proposed): Single family dwellings Manufactured Homes Other (specify)
Comments:
Required Residential Pro eny Une Setbacks:
From Minimum 25 s
9 Actual i t
I loan 3 —
Closest Side w _ �
Sidesueet / comm tot
Nearest Buikimg
on same lot
II penults al gram: gr
agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hemby that 1 t. r statements are accurate and correct to the best of my knowledge. Permit subject to revocation it false information is provided.
; 1 i 9 %1/1D
Sign re of Ow er or Owner's Agent Date
"This application expires 6 months from the initial date It no permits have been Issued"
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER % use H
PURCHASE) or AND L Ink ONLY
REOUIRED WHEN APPLYING FOR LAND USE APPLICATION
9/07
14:1113_ Wdnat Grave
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—SITE-PLAN ^ °1. US
DISTRICT
*BEDROOMS / _ SG II' 1
' L / // Zoning Ad inlstretor /1€ &1
Date
i —.
OWNER NAME: APPLICATION it:
"This application to be filled out only when applying for a new septic system.•
County Health Department Application for Improvement Permit and /or Authorization to Construct
I F TI III INFORMATION IN THIS APPLICATION IS FALSIFIED, CHANGED, OR THE SITE I3 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)
DEVELOPMENT INFORMATION
91 New single family residence
❑ Expansion of existing system
❑ Repair to malfunctioning sewage disposal system
❑ Non - residential type of structure
WATER SUPPLY
U
New well •
❑ Existing well
❑ Community well
g' Public water
❑ Spring
Are there any existing wells, springs, or existing waterlines on this property?
(_) yes {) no (_) unknown
SEPTIC
If applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference, must choose one.
1 Accepted ( Innovative
1) Alternative { Other
( ) Conventional {4} Any
The applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in
question. I f the answer is `yes ", applicant must attach supporting documentation.
{_) YES {_) NO Does the site contain any Jurisdictional Wetlands?
{_) YES {_) NO Does the site contain any existing Wastewater Systems?
{) YES {_) 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?
I 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.
1 have Read This Application And Certify That The Information Provided Herein Is True, Complete And Correct. Authorized County And
State Officials Are Granted • t Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
1 Understand That I Sol ;T • - p ondble For The Proper Identification And Labeling Of Ail Property Lines And Corners And Making
The Site Access ib / I r r. Mete Site Evaluation Can Be Performed.
I
PROPERTY i ',/' ERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
3/07
•