LAND USE Initial Application Date: 1� h I I l) ! Application # Z f Z
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COUN • 'HA' NETT RE' DENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front S NC 7546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 wwww.harnett.org /permits
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LANDOWNER 11 l )\O•Q- � , pp�r // Mailing � Addrr l es ss s: ,L 3 _ l z H-
5 LI5 S1 r'z^ (
City: � St te: N"Zip:i Contact d2 L IQ-t 1 a -7
APPLI NT: / \i 1 L-sr h t\\ QmQ5 Mailing Address: ‘ 2 F aairWa '
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City: f ir State zip o�a�>Y�� �� Email: C� V)o,ln t.., on . rket
'Please fill out applicant ormalion if different than landowner q
CONTACT NAME APPLYING IN OFFICE: I I t 0.fo ( ( C\S Phone R 77i. - 50130 r 42 // (v / (kg
PROPERTY LOCATION: 1. 117 State N l '� : / ' L _ Lot Size; , 7S
State Road # I I I / State Roaad Na '` � $ 0 V /1 — M Book&Page: /
Parcel: 0 a 152 / / 02 / 9 ////// D PIN: 5.2: � / 1) 57 - 6 /oW, 000 `n/�1
h \y
Zoning: 44 ? 1 Flcod Zone: j „.-k 7 Watershed: Deed Book &PageO ? O / Company': ` P55
`New structures with Progress Energy as service provider need to supply premise number 7-12 `` )��/� O from Progress Energy. "`JJ7
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: /0_ %c2 I c5c ti-- 41 1/ 22 C - /3 al ii /es
I- E1 C + fl - . 61 I, s A v g. e � I ! • sinA.: _ 115 m Jt nQQY1�
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PROI'OSED USE:
Monolithic
ti : a% g* rsearoon...., • rsatns = Basemenl(w /wo bath):_ Garage:_ Deck:_ Crawl Space:_ Slab:_ Slab:_
(Is the bonus room finished? (_) yes (_)no w/ a closet? ( ) 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 seco Boor finished ( )no Any other site built additions? (J yes (_)no
11I Manufactured Home: SW �[DW _TW (Siz> # Bedrooms: a_ 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_) Use: Closets in addition? (_) yes (__)no
Water Supply: ♦ County Existing Well New Well a dwellings using well ) *MUST have operable water before final
Sewage Supply: New Septic Tank (Complete Checklist) W 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 1 ct listed above? (_) yes Lke
Structures (existing or proposed): Single family dwellings: Manufactured Homes: Other (specify):
Required Residential Prop rty Line Setbacks: , Comments:
Front Minimum Actual al
Rear " JI
/
Closest Side / 0 FF Si `
Sideslreetkomer lot ' o�' /�
Nearest Building J I. 1,4)
on same lot
If permits are granted I agree to conform to all ord' antes d laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoin ements are acc ate and o r to the best of my knowledge. Permit subject to revocation f false information is provided.
ig atur f Owner or Owners 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
Residenlial Land Use Application Page 1 of 1 07)10
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NAME: APPLICATION it: / 2 C 2C. Z
*This application to be filled out when applying for a septic system inspection.'
County Health Department Application for fm vement Permian 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 MVALID. 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 Iota to be addressed within 10 business days after confirmation. $25.00 return trip fee may be incurred
for failure to uncover outlet ltd. 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
811 (after selecting notification permit if multiple permits exist) for Environmental Health inspection. Please note
• • , i • m. ■b =n , =nt of re •r•in. fo • • •f of r =.u: .
Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
I 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 desired system type(s): can be ranked in order of preference, must choose one.
{_) Accepted 1_1 Innovative 1 -1 Conventional (_) Any
{_} Alternative 1_1 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 1_1 NO Does the site contain any Jurisdictional Wetlands?
{_)YES (_) NO Do you plan to have an ion system now or in the future?
{_)YES (_} NO Does or will the building contain any Wig? Please explain.
I I NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
{_)YES 1_1 NO Is any wastewater going to be generated on the site other than domestic sewage?
(_)YES 1_1 NO Is the site subject to approval by any other Public Agency?
1 -1 YES 1_) NO Are there any easements or Right of Ways on this property?
(_)YES 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.
I Have Read This Application And Certify That The Information Provided Herein Is True, Complete And Correct. Authorized County And
State Omcials 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 L S ti Complete Site Evaluation C Be Performed.
Gl fr /i � Z rl 11/ RE (REQUIRED) D /
PROPERTY ERS R OWNERS L GAL C7�7``''''
11/09
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DIAO • OF A TYP ' AL SEPT! ANK
Warillit
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• UTLET LID
POSSIBLE POSSIBLE
HOUSE HOUSE
CONNECTION - CONNECTION
--► ._____
POSSIBLE
HOUSE
CONNECTION
POSSIBLE LID SHAPES
1 - I SQUARE (SHOWN ON DIAGRAM)
RECTANGLE (OLDER TANKS) - ROUND
PROCEDURES AND GUIDELINES FOR MANUFACTURED HOMES
Replacement & Removal Criteria
I, � l , . . . f i c ✓ _ i , ! - - - , , do hereby certify the following:
(P t ame /
1. That I own a tract of land located on SR /7/ 2- i an RA -30 / RA -40 or RA -20R /RA -20111
district which has a functional septic tank;
2. That the existinalgr ouble -wide manufactured home is to be removed or was removed on
/,,'— 7 / - J((.;
3. That I am replacing an existin sing) double wide manufactured home with a singl double wide
manufactured home, and; /�
4. That the replacement of this manufactured home creates �G--.residence(s) on this single tract of land,
and; Jr--
5. That there will be manufactured home(s) on this single tract of land and I do , o not own
property within 500 feet of this tract that contains a manufactured home.
6. The home must have a pitched roof, for a manufactured home, whether A - shaped or rounded, which
has a minimum rise (measured at the center of the home) of twelve (12) inches for every seven (7)
feet of total width of the home. (Example: A home measuring fourteen (14 ft.) in width must have a
twenty four (24) inch rise as measured from the center of the roofline to the baseline of the roof.)
(See Illustrations Below.)
14' 118181 ut1 w fl a , "' s €v e,
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Note: Most Rounded Roofs
Will Not Meet The Roof Pitch
_mot e.: ,. The Measureme t From The
T s .: ® e8ig a Peak Of The Roof To The
'Med <� T� � g, I ipp , ; Base Line Of The Roof Must
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Pitchh; ' s ) ' , , a ry ,
Be 1 2 For Eve 7 f o
r' Width Of The Home. O (14
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iii 1,i w Wide Home = 24" Roof Rise) in#
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7. The home must be underpinned, the underpinning must be designed . for manufactured homes &
installed in good workmanship -like manner along..the entire base of a manufactured home, except for
ventilation and crawl space requirements, and consisting of the following: metal with a baked —on
finish of uniform color; a uniform design and color v_inyl; or brick, cinder block, and stone masonry as
well as artificial stone masonry.
8. The homes moving apparatus removed, underpinned or landscaped. _ , . ' ' .'
9. Select One of the Following Options Below:
a. The current manufactured home will be removed prior to the Zoning Inspection.
The current manufactured home is scheduled to be removed through Project AMPI
c. The current manufactured home will be removed after the final inspection has been performed
and the certificate of occupancy has been issued. (Additional Fees & Requirements Shall Apply)
*(Additional Information for Option C) Temporary approval for replacement of a manufactured home is
allowed only under the procedures and limitations stated below.
Please initial next to each item to indicate that you understand and have or will comply as necessary.
1) A valid manufactured home moving permit must be submitted for the removal of the existing home located
on the property.
1 2) A copy of a Bill of Sale or a Title Transfer of the existing home must be submitted.
1 3) Items 1 & 2 must be submitted to Central Permitting prior to your permit issuance.
4) Property owner /agent acknowledges that due to the fact that a second zoning inspection is required, in
order to facilitate this request, a re- inspection fee in the amount of fifty ($50.00) dollars shall be paid
during the permitting process.
I 5) Once the home has met all other zoning requirements, a temporary approval shall be granted in order
to proceed with obtaining a certificate of occupancy. From the date the certificate of occupancy is issued,
the property owner shall have five (5) business days to remove the pre - existing manufactured home.
6) Property owner /agent acknowledges that if the pre- existing manufactured home is not removed by the
specified time of five (5) business days that he / or she shall be in direct violation of the Harnett County
Zoning Ordinance. And by creating a violation of the Harnett County Zoning Ordinance shall subject
themselves to enforcement actions, penalties, and fines specified within Article XV, (Administration,
Enforcement, and Penalties) of the Harnett County Zoning Ordinance. Each day the violation continues is
a separate offence and is a misdemeanor punishable by a fine not to exceed one hundred ($100.00) dollars
or imprisonment not to exceed thirty (30) days.
I 7) Property owner /agent acknowledges and affirms that the guidelines, procedures, and requirements
associated with the replacement of a manufactured home and the penalties for creating a violation of the
Harnett County Zoning Ordinance have been explained and accepts this document as an initial notice of
violation.
Signa"re # ' peaty Ow ne a te
w 4 At
*By sig g t is form the owner /agent is stating that the have
read and understand the information on this form
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