LAND USE (j2 uaIAppIicauonDate: l / � 7— /t9 Application p ` ` C.70 (p /
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting Front 108 E. Fro Street, Langton, NC 27548 Phone: (910) 893 -7525 Fax: (910) 893-2793 1 wvachameft.org/permits
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LANDOWNER: l� a . I r y A ) 3 u ; N 5 Ma o y ddresa: g v 92 '7 / f 4/ 0, V- �C. a d
City: p0u7 /w a q a /'t State: C Zip: )013j contact * - 3 9 i - /21 D Ernst
% ( filo. Mailing Address:
City: State: Zip: Contact 0 ,Email:
'Please All out applicant information if different than landowner 4 /
CONTACT NAME APPLYING IN OFFICE: 4
ly 13 oU M S Phone a golf- 3 9 2 - 1 Z i 7 /
I PROPERTY LOCATION: Subdivision: Lot 6: Lot Size; / /, 74 ,�
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State Road 11 / State Road Name: /' • 4 4/1• 4-2 /� d �/ Map / b0�
p BB0 /Y /� ✓�J
Parcel: ✓//JA Z7 ago (2
PIN: ` 7 — Y// — ,
Zoning: . /f 2 lood Zane:_ /l Watershed: !/ Deed BaokSPege: 2 7 1 / / / Power Company:
New structures with Progress Energy as service provider need to supply premise number from Progreso Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM ULUNGTON: 90 I 5o0411 4 o 2 r 0 S co (
a pph%A, 6(m,les 14 Oa1 --olh a) an R ;il 17 Ap 2w.,
'1m 2,c".g2, nkrkoc -14 Re) oti Ri711,
PROPOSED USE:
Monolithic
❑ STD: (Size )c ) * Bedrooms: *Baths: Baeement(wAvo bath): Garage: Dedc: Crawl Space: Slab: Slab:
(Is the bonus room finished? Li yes (_)no w/ a closet? Li yes (Jno (t yes add In with • bedrooms)
❑ Mod: (Size x 16 Bedrooms 6 Baths Basement (w/wo bath) Garage: Site Built Dedc On Frame Off Frame
(Is the s,cand floor finished? U yes (Jno Any other site bulk L.,) (__)
additions? ) yes Lino
Manufactured Home: _ SW s DW TW (Size 2 ' x 5L) # Bedrooms: Garage: (site buik?_i Deck: (site bulk? )
❑ Duplex: (Size 4 ) No. Buildings: No. Bedrooms Per Unk:
❑ Horne Occupation: 6 Rooms: Use: Hours of Operation: *Employees:
❑ Addition/Accessory/Other. (Size c ) Use: Closets in addklon? (._) yes Lino
Water Supply: A County _ Existing Wen _ New Well (0 of dwellings using well ) *MUST have operable water before final
Sewage Supply: _ New Septic Tank (Complete Checldlsf) % 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 (50d) of tract listed above? (_J yes (ono
Structures (existing or proposed): Single family dwellings: Manufactured Homes: Other (specify): AoTv h S
Required Residential Property Line Setbacks: Comments:
Front Minimum 3�7 Actual / 2 4'
Rear 2 5 ' l y o f
Closest Side /(9 ,0
Sldeetreet/comer lot
Nearest Bunding
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 scat �ar�e accurate and
d{ � /� p J -erect to the best of my knowledge. Permit subject to revocation if false information Is provided.
I � Owner or Owner's Agent 0
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
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9 NAME: G a hey So k h se APPLICATION #: / 015— ZC Z ,
*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 64) months or without expiration
depending upon documentation submitted. (Complete site plan = 60 months; Complete plat = without expiration) // 2 i 9//
910 -893 -7525 option 1 CONFIRMATION # tf
❑ 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 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 if multiple permits exist) for Environmental Health inspection. Please note
confirmation number given at end of recordina 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 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 I Conventional 1_) Any
(_) Alternative 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:
{OYES 1_1 NO Does the site contain any Jurisdictional Wetlands?
{_)YES {,X1 NO Do you plan to have an irri anon cvctem now or in the future? rr rl ,.,
(X)YES (_) NO Does or will the building contain any ? Please explain. 1/1-0.1 H fah- h- DO m e S f t C. 5 eta/Q 9C
(IYES 1 — NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
{_)YES ( ,X) NO Is any wastewater going to be generated on the site other than domestic sewage?
I_)YES IX NO Is the site subject to approval by any other Public Agency?
I_IYES ILI NO Are there any easements or Right of Ways on this property?
( OYES 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 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 Ac le So That A Complete Site Evaluation Can Be Performed.
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PROP TY OWNE S OR OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
11/09
DIAGRAM OF TYPICAL • EPTIC TA ,_
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• UTLET LID
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POSSIBLE POSSIBLE
HOUSE HOUSE
CONNECTION _ CONNECTION
POSSBILB
HOUSE
CONNECTION
POSSIBLE LID SHAPES
1 _ I SQUARE (SHOWN ON DIAGRAM)
RECTANGLE (OLDER TANKS) _ ROUND
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liSaleir 1281i914i42
C REV ST119: .00
. �BY
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t for h Do NOT write above Mrs lbw
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Carolin nt 4 Book e e
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Thh kutrument A General Warrant Deed
M prepared In A.dI E. • n AttOm_ at Law
TAN Deed mods Iles 7N�
EnteD In appropriate 3 bl «k lore —�dey of S_pe tmnhu
designation anOnmat end lcnntn petty. Name, address, 10t0
plural, masculine, feminine or neuter a yin AValn bMD nt e x t . �p n � ann R M l r Ml n; prteb anti heM ben Grantor end Grantee. Gunton regWnd by contest padres, casaon Gl..atc n, pe cl,j4. l -The
THOMAS B. JACKSON, widower pe° and Meg Inehna singular,
2009 Powell Perm Rd,
Grantee: Lillivgton, NC 27546
GARY A. BURNS
8492 High Point Rd-
TreOefer O(Ownership: Gr D ouglaaville,: GA 30134
In /« Maple, Me Property described low: va luable wn,NanlMn paid by Grantee, Me rocal .
pt of Mkh h hereby «Itgd
Property: coy of atlWd, calmly, to Grantee
remain of Anderson Creek
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This propenY pea, ecquked by On ntor .County of H aman
A mew , howls Me properly Man 1 1 Book /Cabbie F Slide rocann N Boo 1063 1
Mowing p W ry b recorded m PIE Bk nt We 450.8 P°Ps en North Carolina. N tlnmlpd a/Me Prawn h: .
�-- -�,vros ,xem—— canmr.
BEING ALL OP THAT PARCEL OF LAND containing 4,24 acne, loco CWT'
the kP
Creek Harnett County, North Carolina, u Mown a located ^n Stele
Creek Jackson and Township, Harnett M& J. Knell", prepared by Bennett Pon a plat entitled 'Survey Road No. 1125 (Dem In Road), In Thomas B.
mef County Registry. Reference m said map is hereby dated A 5 grat cc 5 red ofdN°�cdbm PW P, Slide 450 -B, Ha
by made for a grat eu nNty of description.
SUBJECT PROPERTY DOES NOT MCLUDE THE PRIMARY RESIDENCE OF THE GRANTOR.
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Continued onO
After recording mall to: age
Mc0 A. Bums
Tax Lot M.�''i;
8492 Nl h P int Ad Perml ld«d6y tn. JR d0010d2
D 1 VnfladB .
on Me d ay — County, B 20
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Fenn 66807 ®2002 by Jm«a Williams bCo., Ina RwwJ M1kl
Pepe 1 of 21ndlel
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PROCEDURES AND GUIDELINES FOR MANUFACTURED HOME INSPECTIONS
fi /�) RA -20R & RA- 20M Certification Criteria
I, a 1/44,,,,.a , understand that because I'm located in a RA -20R or
RA -20M Z District and wish to place a manufactured home in this district I must meet the
following criteria, verified by zoning inspection approval, before I will be issued a certificate of
occupancy for this home.
1. 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.)
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Note: Most Rounded Roofs Will
,,,s ;g y. F... 4111 . i � Not Meet The Roof Pitch
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f 7 . . 2 ' Requirement As Illustrated. The
Measurement from The Peak Of
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I I No ^ ° The Roof To The Base Line Of
if The Requl Ip R ffP,itc ;7'4
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'�E t b ,,�' � w� „,k;u, ? l , The Roof Must Be 12" For Every
1 ��r. 1'7. ' n
t � 7' Of Total Width Of The Home.
(14' Wide Home = 24" Roof Rise)
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2. The home must be underpinned, consisting of a brick curtain wall or have
galvanized metal sheeting, ABS or PBC plastic color skirting with
interlocking edges, installed around the perimeter of the home. Skirting
shall be consistent in appearance, in good condition, continuous,
permanent, and unpierced except for ventilation and access.
3. The homes moving apparatus must be removed, underpinned, or
landscaped. (See examples below.)
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Signature of Pr. perty Owner / Agent Date
• By signing this form the owner / agent is stating that they have read and
understand the information on this form.