LAND USE Initial Application Dale. ! /7 - Ii Application # / 2-5-7 3/
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPUCATION
Central Permitting / 108 E. Front Street, Lillington, NC 27546 / Phone: (910) 893 - 7525 Fax: (910) 893 - 2793 www.hameti.org
LANDOWNER: _ t j/,./4 ,%' t NJ at_214,rarling Address: 1Q"�y( " ocOIL) N•
City: I IWI 1
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State: :J / ZJp: V 0 ) Home #: (���r Cordad #: ill 1t2J lag
APPLICANT*: j4L h i.ir k5 /GU.(l&f. Mailing Address: /'I# le, As �Ve
City: �Jl Stale: Zip; Home #: Contact #:
tloasu Idl out applicant information it different Than - •• • ll_ (�^^ -
CONTACT NAME APPLYING IN OFFICE: 4. ✓ [ 11r/t✓7 Phone #: 919 411 7 06
•
PROPERTY LOCATION: Subdivision: 1 81111* Lout 39 Lot Size: .$ I �f
Slate Road #:_204C Stale Road Name: LAS& OS Q5— / Map Book &Page: / 7,Q
Parcel: 0 Jn5a5 rx�Q X �'''� ,�/ PIN: c)Q5— ` -7139 q�/�,
Zoning: RA-Q R Flood Zone: / 1 Watershed: 1 V jd / Deed Booh&PageA 7, oY-77 I
SPECIFIC DIRECTIONS TO THE PROPERTY FROM ULUNGTON: UO/' r r t r t I C- 9 /
c9 0 50 16njes /re -\- on Ltas4 r rd. Wp n4 v rove .5 em i
PROPOSED USE: Circle: // __ Circle:
t
at SFD (Size W x t+(/ ) # Bedrooms 3 D Bad ^ s d Basement (wlwo bath) Garage / Dock / - rl / Slab
❑ Mod (Size x ) # Bedrooms a Baths Basement (vdwo bath) Garage Site Built Deck ON Frame / OFF
❑ Duplex No. Buildings No. Bedrooms/Unit
❑ Manufactured Home: SW _DW TIN (Size x ) # Bedrooms _ Garage _(site built? ) Deck (site built? )
❑ Home Occupation # Rooms Use Hours of Operation: #Employees
❑ Addltior✓Accossory /Other (Size x ) Use Closets in addtion(Jyes (__)no
Water Supply: Aft County . ( ) Well (No. dwellings ) MUST have operable watel before final
Sewage Supply: Lk) New Septic Tank (Complete New Tank Cheddlsf (__) Existing Septic Tank ( ) County Sewer
Property owner of this tract oI lard own land that contains a manufactured home WM five hundred feet (500) of tract listed above? (__)YES L)NO
Structures (existing or proposed): Single Wady dwellings Manufactured Homes Other (specify)
Comments:
Required Residential Property Line Setbacks:
Front Minimum /5 Actual
Rear Q5 /0
Closest Side 10 21
Sidaslred/cornerlot aU 75
Nearest Budding
on same lot
If pormlts 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 het st Ih for log statenrea accurate res
s are accate and ca to the best of my knowledge. Permk subject to revocation 11 lo
false information is provided.
9/64)
Si re of Owner or Owner's Agent Date
"This application expires 6 months from the InDiaI date It no permits have been Issued°
A RECORDED SURVEY YAP, RECORDED DEED (ON OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
Please use Blue or Black ink ONLY
9/07
f 3 i t = Waandt Grove,
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DISTRICT - � _ - -�
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% � Zoning Administrator
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OWNER NAME: APPLICATION N:
'This application to be tilled out only when applying for a new septic system.•
County Health Department Application for Improvement Permit and /or Authorization to Construct
I F T1 II:. 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)
DEVELOPMENT INFORMATION
A New single family residence
❑ Expansion of existing system
❑ Repair to malfunctioning sewage disposal system
❑ Non - residential type of structure
WATER SUPPLY
❑ New well
❑ Existing well
❑ Community well
Jt Public water
❑ Spring
Are there any existing wells, springs, or existing waterlines on this property?
l_I yes {X} 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
{} Alternative {_} Other
1 Conventional --{S} 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?
I IVES {X} NO Is any wastewater going to be generated on the site other than domestic sewage?
IVES {2} NO Is the site subject to approval by any other Public Agency?
1_1 YES {J NO Are there any easements or Right of Ways on this property?
1_1 YES t 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 !lave 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 Am Sol For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site A • So The plete Site Evaluation Can Be Performed. Y[�
PROPER r NERS W NERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
/ 3/07