DOCUMENTS Initial Application Date: ,C
i JI ' / Application# 19 SOO Li IrJ-C L CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.harnetl.orglpermits
^A RECORDED SURVEYhI� MAP,
RECORDED DEED OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIJRED WHEN SUBMITTING/A LAND USE APPLICATIOP
LANDOWNER: ,` IID Y IK✓ I-6NTkt S Y1 C 1/ Mailing Address'. alyl: et An PA
City: f CLy VSf�Ji��Q State'_Zip! L 3/ Contact No. RI 2ZI -9901 Email: OMaiI P-WInk Le 1.1JQ4/nt . tent.
APPLICANT'/: Mailing Address:
City: State: Zip. Contact No: Email:
'Please 0l out applicant information if different than. 1Asnb AWL landownernd
CONTACT NAME APPLYING IN OFFICE: 1t35 Phone# Iq
(0 303-0 2.c
PROPERTY LOCATION:pSubdivision: CI M.IAJyb✓TY1 _ /s L, Lot#: 3( .Lot
Siize': 67 Lc
cc'P5
State Road# //��1�� � ��tt State�Road
�NName: VV A 1 e.4J1 C2 ! Map Book&Pagd QII"I Os'btp
Parcel. I , LJI�Lia O )CU 3,x \I�/1 PIN: Ole(OZ(Y.,-J�^S2-'116(1')33 000
Zoning 30 Flood Zone: X Watershed/1/434\ Deed Book&Page34 S i Q43 Power Company*:
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
/SFD:(Size PROPOSED USE:
x L
Monolith;
[Y 1$ 4.17 #Bed rooms lq ,/ .
:�#Baths Basement(w/wo bath)'. Garage.. Deck: Crawl Space: Slab: Slab.o _
(Is the bonus room finished?(_)yes (_)no wl 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 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:(Sizex )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/(#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 five hundred feet(5009 of tract listed above?( )yes ( o
Does the properly contain any easements whether underground or overhead(_)yes (�reI rlo
Structures(existing or proposed):Single family dwellings: t ����Maan�nufactured Homes: Other(specify):
9 P"�--ss���"=^
Required Residential Property Line Setbacks: Comments:
Front Minimum-2-i-TT S Actual 52) COr% Ql
Rear r1a✓ S9T S
Closest Side I a LO
❑ te9rorngr lot
Nearest Building
on same lot
Residential Land Use Application Page 1 0l2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC •
^^DIRECTIONS TO THE PROPERTY FROM ISLINGTON: c?- C\N \b1'Aa 1T `R erte—LI
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If permits are granted I agree to conform to all ordinances and laws of the State of Norm Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing s em nts are rate d correct to the best of my knowledge. Permit subject to revocation if false information is provided.
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Signature ner or Owner's Agent Date
"It is the owner/applicants responsibility to provide the county with any applicable information about the subject property,including but not llmaed
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 N permits have not been issued"
Residential Land Use Application Page 2 of 2 03/11
SITE PLAN APPROVAL
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NAME: .j!‘l tx 1-*--H dYr?wj APPLICATION rt:
*This application to he 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#
Li 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 properly
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 underorowih 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 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
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 put Ild 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 { I Innovative Isnventional I—I Any
I_I • le Ge I_1 Other
The mplicant sh.Il notify the local health departme I upon subm ttal of this application if any of the following apply to the property in
questi n. If the a swer is"yes",applicant MUST TTACH SU'PORTING DOCUMENTATION:
II ES (—I 0 Does lin to h to a any Jurisdictional3siinowWetlands?
I_I S 1IN Do you plan mh �e an'_.�_ 'OaS s ' now or in the future?
{ }Y 'S I—I NIT Does or will the wilding contain any c t''as?Please explain.
I_IY•S {__ I NO Are there an existing wells.springs, war rlines or Wastewater Sy ems on this property? I\
IIV: I_I NO Is any was 'water going to be generated the site other than r nestle sewage?
I_IYE. ( I NO Is the si - subject to approval by any othe Public Agency?
(.__I YE' IJ NO • . ere any Easements or Right of Ways n this pro. rty?
( I YES I—I NO Dues the site contain any existing water,cab -.ne 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 A ee"ssiibfor
¢�So That 'omp to Site Evaluation Can Be Permed. 3
PERTY OWNERS R OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATES nCk
10110