LAND USE Initial Application Date: /1 / - /' Application # �✓ C -9C 25 Y2
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 27548 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.harnett.org/pennits
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LANDOWNER: .4-1.) /3-OPer -tvs - Mailing Address:
City: /� T- Stale: Zip: Contact # Email:
APPLICANT': / COwtA# -t Aa t93 -�C • Mailin g Address: Po •- -3‘11 ,�t
City: Cla State 22 ! Zip Contact # 4t c.15 ••3Z EmaliCatr /o.Nn &Qej•
'Please all ordappllcant Information if different than landowner `4
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CONTACT NAME APPLYING IN OFFICE: ' .S14.c we .rs[ ,rf, Phone # JJ1 A• 2 4 Z e ,-9,Z2 - / S
PROPERTY LOCATION: Subdivision: res[ [ n,,. 1 s Lot #: t p 7 ! Lot Size:Q' 9✓ c„
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State Road # (''# / Z State Road Name: C L J s ,* / Map Book &Page:20 I 4 1 6 ?
Parcel: OS/D6 S ?O // ,s05 PIN: 06 4. y -36 -S43 (• O CIO
Zoning:J( ;OFlood Zone: ' \ Watershed: (N Deed Book &Page: Gr'r/ / Power Company':
New structures with Progress Energy as service provider need to supply premise number 355539. 16 from Progress
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Yes( (1r r C 'ttfo ;1k«r� L .f Ifes /
R.fl ^ ,t,, Stele P ;.. Z (TT (ttf. d J 3a7on
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PROPOSED USE:
r w , ' Monolithic
SFD: (Size x 93 ) # Bedrooms:3 # Baths: , Sasement(w/wo bath):typarage:, 'Deck Crawl Space:, Slab: Slab:
(Is the bonus room finished? (J yes ( )no w/ a closet? ( ) yea L Jno (If yes add in with # bedrooms)
O Mod: (Size _ x ) # Bedrooms # Baths Basement (w /wo bath) Garage: Site Built Deck: On Frame Off Frame
(ts the second floor finished? (__) yes (__)no Any other site built additions? (__) yes (ono
O Manufactured Home: _ SW DW _ TW (Size x ) # Bedrooms: T Garage: (site built? ) Deck: (site built? )
O Duplex: (Size _ x ) No. Buildings: No. Bedrooms Per Unit:
O Home Occupation: # Rooms: Use: Hours of Operation: #Employees:
O Addition/Accessory/Other. (Size _ x ) Use: Closets In addition? (3 yes (__)no
Water Supply: County _ Existing Well _ New Well (# of dwellings using well ) 'MUST have operable water before final
Sewage Supply: New Septic Tank (Complete Checklist) _ Existing Septic Tank (Complete Checklist) _ County Sewer
Does owner of this tract of land, own land that contains a manufactured home within live hundred feet (500') of tract listed above? (J yes"4no
Strudures (existing • • ropos Single family dwellings: ( Manufactured Homes: Other (specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum 35 a Actual_ 4o
Rear
2 S
Closest Side /0 ZO
SidestreeVwrner lot ; 245 _l//_
Nearest Building
on same lot
II 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 Ma nts are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
Signature of Owner or Owner's Agent Date
"Thle application expires S months from the Initial dale 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: LOS ° ti—Ststeir APPLICATION if:
*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 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)
910- 893 -7525 option I CONFIRMATION #
X Environmental Health New Septic System Code 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 retum trip fee may be incurred
for failure to uncover outlet lid, mark house corners and property lines. etc. once lot conflmled 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
piven 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 {_} Innovative {2(} Conventional {_} Any
{_} 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.
{_ }YES p,NO Does the site contain any Jurisdictional Wetlands?
{_ }YES 0c4 NO Do you plan to have an irrieat system now or in the future? � ,,// c
(N YES {_)) NO Does or will the building contain any draip1? Please explain. erf,7• a %a.'.1 40.064$64%.
( I x) NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
{_ } YES {) NO Is any wastewater going to be generated on the site other than domestic sewage?
{ }YES (A NO Is the site subject to approval by any other Public Agency?
{_ }YES ( k) NO Are there any easements or Right of Ways on this property?
{_ )YES {K 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 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 Accessible So That A Complete Site Evaluation Can Be Performed.
/v /U
PROPERTY OWNS OROWNERS GAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
October 26, 2010
Comfort Homes, Inc. has an option to purchase Lots 96 anigOn Forest Trails Subdivision, recorded
in Map Book 2008, Page 409, Harnett County Register of Beds.
(Seal)
I, Patricia F. Waite, do hereby certify that Julian R. Stewart, President of Comfort Homes, Inc.,
personally appeared before me this day and acknowledged the due execution of the foregoing
instrument.
Witness my hand and Notarial Seal, this 26th day of October 2010.
�� 11, s��• \ (Notary Public)
My commission expires 4/2/12. ,,, +IIIII
So, OTARy'r
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