LAND USE r F Initial Application Date: it AP — /0 Application 0 • /0 '7 a, 5 2 4V - Op
CU* COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, IJllIngton, NC 27548 Phone: (910) 893-7525 Fax: (910) 893 -2793 www.hamett.orglpennits
LANDOWNER: ..bt' f -b SL M.a\& t. S Mailing Address: P(7 B0-C (o
City: C'0Ar State: NC-Zip: Z7521 Contact # Email:
APPLICANT`: - MIT) Wit.; crltiNfrO f0 i Mailing Address: C3103 N 614 13o ,.
City: (JUw State: t zip: 7 433 . 3%ontact 0 `117 477.0q (RS Email: toad @ w}:,k ?€A inbuilrlars,6
`Please tiii out applicant Information If different than landowner COPY)
CONTACT NAME APPLYING IN OFFICE: ebb W \ rr - rsrTV Phone # q 1 ry • L(2 -Sq (o7 // pp �77
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PROPERTY LOCATION: Subdivision: r - RrrL rv� .�c.{zD �'„ I�C?.� Lot � Lo t / Size _ /•
State Road* State Road Name: r ANC 'Ml Lt_ Map Book&Page: ,Fee
k&Page: C I7 /
Parcel: Q O ° 1 c cx OA A /{� PIN: /4 `( ^ / / 14 - AJ 2 Z {i
Zoning: 84 1 16O Fbod Zone: /� Watershed: A/ Deed Book&Page: / S 2 ^ / blOz Power Company ":
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM ULLINGTON: W &J. 1 N (r }-1 U v1/45 P. L. P"& MILL 12 b
C..,,AT S NC 7.2157-1, '4IWA' 2-1 GASH' cx-c 6E CoA7S TO i3EN50r3, Tula, R, &HT orQ
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PROPOSED USE:
Monolithic
❑ SFD: (Size _ x ) # Bedrooms: # Baths: Basement(w/wo bath): Garage: Desk: Crawl Space: Slab: Slab:
(la the bonus room finished? U yea Lino w/ a closet! (J yes Lino (k yea add In with # bedrooms)
❑ Mod: (Size _ x ) # Bedrooms 0 Baths Basement (w/wo bath) Garage: Site Bulk Deck: On Frame Off Frame '
(Is the second floor finished? (, yes (ono Any other site bulk additions? ( ) yes Lino
❑ Manufactured Home: SW DW - _ 11N (Size x ) # Bedrooms: _ Garage: (site bulit?J Dedc built/
❑ Duplex: (Size X ) No. Buildings: No. Bedrooms Per Unit:
'�❑ Home Occupation: 0 Rooms: Use: Hours of Operation: #Employees:_
J�" AdditbNAcceaeory/Other. (Size 4 x 30) Use: r, /6 roil iAG Closets in addition? ( ) yes. no
/
Water Supply: _ County Exleting Well _ New Well (# of dwellings using wed )*MUST have operable water before final
Sewage Supply: _ New Septic Tank (Complete Checklist) , Lo" Existing Septic Tank (Complete Checklist) _ County Sewer //
Does owner of LS tract of land, own land that contains a manufactured home within five hundred feet (500 of tract listed above? (� yes (y3no
Structure ear proposed): Single family dwelilngs: F'Ml1ST) NC. Manufactured Homes: Other (specify):
Required Residential Properly Llne Setbacks: Comments: LO r 15 t 1 c! IRC.. it LS W \'r 1 - 1 N (>
Front Minimum 3 S Actual 247 PRo t.1 a h5 C
Rear 7 4 30-3
Closest Side /U N 61-
SldestreeHcorner lot
Nearest Building 405 *
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 me are accurate and correct to the best of my knowledge. Permit subject to revocation if false information Is provided.
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Signature of Owner or Owner's Agent Date
"This application expires 8 months from the Initial data 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
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NAME: v�GN \U S-35 APPLICATION #: /0 S -90: 2 5 - 4 - 17 .
*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 IMPROVEMENT
PERMIT OR AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. The permit is valid for either 60 nths 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.
• Al! 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 it 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 put lid back In place. (Unless inspection is for a septic tank in a mobile home park)
:' '; DO NOT LEAVE LIDS OFF OF SEPTIC TANK
• 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.
( — I Accepted 1 —) Innovative I r� Conventional {_I Any
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:
(_IYES (✓ NO Does the site contain any Jurisdictional Wetlands?
(_)YES 1 ✓1 NO Do you plan to have an irrigation syste now or in the future?
{_)YES { '1 NO Does or will the building contain any ? Please explain.
I —IYES ILI NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
(_)YES I NO Is any wastewater going to be generated on the site other than domestic sewage?
{ —}YES I ✓) NO Is the site subject to approval by any other Public Agency?
I_(YES I V) NO Are there any Easements or Right of Ways on this property?
{_)YES {/j 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 An9 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 1 Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site A east o T A.0 lete.Site. Eyaluation Can Be Performed.
PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
10 /10
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DIAGRAM ' - A TYPI' AL SEPTIC ANK
— ,
• UTLET •
e
POSSIBLE POSSIBLE
HOUSE HOUSE
CONNECTION — CONNECTION
T
POSSIBLE
HOUSE
CONNECTION
POSSIBLE LID SHAPES
1 — 1 SQUARE (SHOWN ON DIAGRAM)
RECTANGLE (OLDER TANKS) 0 ROUND