LAND USE R Initial Application Date: and - ' Application# I r7 SC "4 di
CLOS
I PLICATION
�� COUNTY OF HARN&S
Central Permitting 106 E. ont Street,Lillington.NC 27546 Phon Fax.(910)893-2793 www.hamad.orcypertnits
^A RECORDEDpSURVEY MAP,RECAP.-RRDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED MIEN SUBMITTING Ay LAND USE APPUCATIOM'
LANDOWNER: / I I n O IC I •(e i -'/Pro s Mailing Add
ress: d/��� Z1ei r``C4 L/L/� p/
City: /—vrj Vol/ VAr 0, State:/✓t Zip: 7 . Contact No: W 3741 8 Email: / rla..b//`ewe f tar
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APPLICANT': Mailing Address:
City: State' Zip Contact No: Email.
'Please IW out applicant information if different than landowner
err o l� p p pm t
CONTACT NAME APPLYING IN OFFICE: aII�C$ cy 1 co I V CC J Phone# /// -Sir 2 2-20
PROPERTY LOCATION:Subdivision:
Subdivision: • 1L es 10 i l y 1 Lot#:S7 Lot Size: •l/
State Road# W�5 •
Stale Road Name: ' _ ,L _ ` ,,ap Book&Page: 0201 en/
Parcel 050G3S0lotii /G PIN: 0G2s-6-9 - .7yyeZ
Zoningl^r(� ✓"r mood Zone: ) Watershed:t'+.P Deed Book B Page: c200‘I DAY Power Company':
New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
r Monolithic
X[ SED':(Size Yo x 1JY5 )#Bedrooms: 9 #Baths:&Basement(w/wo bath):NA Garage: I Deck: Nt Crawl Space:)Slab:_Slab:
(Is the bonus room finished?( )yes (6)no wl a closet?( )yesY(LR)no(if yes add in with#bedrooms)
U Mod:(Size x )#Bedrooms_#Baths_Basement(w/wo bath)_Garage:_Site Built Deck: On Frame Off Frame
Is the second floor finished?( )yes (_)no Any other site built additions?( )yes ( )no
❑ Manufactured Home- SW DW TW(Size x )#Bedrooms: Garage:_(site built?_)Deck' (site built? )
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
U Home Occupation:#Rooms: Use: Hours of Operation: #Employees:
❑ Addition/Accessory/Other(Size_x_)Use: Closets in addition?( )yes ( )no
ss
Water Supply: ) County Existing Well New Well(#of dwellings using well )'Must have operable water before final
Sewage Supply: X 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 five hundred feet(500')of tract listed above?( )yes Lk)no
Does the property contain any easements whether underground or overhead(X)yes O no
Structures(existing or ant gle family dwellings: 31, a9:41/1
nuutacturre(((d HHomes: Other(specify):
Required Residential Property Line Setbacks:ks( Comments: n31, ty,/`s�}h1/" /y-� t
Front Minimum 3f Actual 3 . O J..) lrU(_i^-en ,,— P_ C o r#-L_- -
Clos /0 F, \ \0J \'Yc
f
Closest Side ,1 0
Sidestreeucomer lot A]N
Nearest Building /1/A
on same lot
APPLICATION CONTINUES ON BACK
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SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: /J' t t I✓ef77 O A 4G A;^A Ly / 4 nj
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Iferebysare grantedhagneetoe ntsorm to all nc ws of State of North Carolina rmitsbje oworkand the
lse informatioofprosdedmittetl.
I hereby state that foregoing stale n�e ccu to q the bast of my knowledge. Permit subjecttor�j'oration if false information is provided.
Tat /�
Si More of Ow er or Owner's Agent ate
"'It is the owner/applicants responsibility to provide the county with any applicable Information about the subject property,including but not limited
to:boundary information,house location,underground or overhead easements,etc.The county or its employees are not responsible for any
incorrect or missing Information that Is contained within these applications."'
"This application expires 6 months from the Initial date if permits have not been Issuer
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NAME: Tv is-1 le a•e el-OS APPLICATION 8:
*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#
4Q 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 lots to be addressed within 10 business days alter confirmation.$25.00 return trio 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 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.
Li Environmental Health Existing Tank Inspections Code 800
• Follow above instructions for placing flags and card on properly.
• 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.
{X} Accepted I—I Innovative Conventional {_i Any
1_) Alternative I_I 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 I NO Does the site contain any Jurisdictional Wetlands?
I_IYES (St NO Do you plan to have an irrigation system now or in the future?
I_IYES Iii NO Does or will the building contain any drains?Please explain.
i—}YES 1X1 NO Are there any existing wells,springs, waterlines or Wastewater Systems on this property?
{_j YES I. NO Es any wastewater going to be generated on the site other than domestic sewage?
{_IYES IX.NO Is the site subject to approval by any other Public Agency?
{AYES I—} NO Are there any Easements or Right of Ways on this property?
I)5IYES 1_I 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 Mid Rules.
I Understand That I Am Solely Responsible For The Prope Identification And Labeling Of All Property Lines And Corners And Making
evi
The Site Accessible So That A C Mete Site lu to e Performed
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Flay`<�/ 1 c2 e/
PROPERTY OWNE R O ER LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) ATF.
10/10