DOCUMENTS Initial Application Date':2V 17I / Application I � ••O 7
CUP
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street.Lillington,NC 27546 Phone:(910)893-7525 ext2 Fax:(910)893-2793 www.harned.orglpermits
"A RECORDEDTTSURVEY�� MAP,RECORDED DEED,x (OR OFFER TO PURCHASE)8 SITE PLAN ARE REQUIRED WHEN
SUBMITTING A LAND USE APPLICATION^
LANDOWNER:_ ,L.r I(r 7 7L A ) L.t-5 X11 Mailing Address: K'EIA c )1 u -124 , I ��,1 }.A�
City: 1 A Yls State: Zip:215/Lontact No. Email:Q r I C!l� 4I I F(U 1 1IYYYl 1 I r wq
APPLICANT': Mailing Address: /� CO 1 `,^1I,,,
City: Stale: Zip: Contact No: Email: e r I l O Y I I I [1JNi-re:1 I '
'Pleasefill out applicant information if different then landowner
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CONTACT NAME APPLYING IN OFFICE:rn i11 � TIUCcf(.�5 Phone# `-I l Ci—(r JL -5IkLJl7p
PROPERTY LOCATION:1 ,,Subdivision: ' I^t�-]�.��Qµ�-� 3tp Are_ Lot ft: Lot Size: •S' le �
State Roadoft at.O State Road Name: 1'at 1` 15 riot Map Book&Pag H O1 2S4
ParceCC j I log)
�/ Vc LQ0 a PIN: I(CI
11 1_i �31 FC' 1 rice
Zoning '?lopd Zone:/� Watershed:_�aDeed Book&Page3 L1 .Power Company': \ ixt QP 9,..)QY�V`J'
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Sizex )#Bedrooms:_#Baths:_Basement(w/wo bath):_Garage: Deck:_Crawl Space: Slab:_Slab
(Is the bonus mom finished?(_)yes ( )no w/a closet?( )yes (_)no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms_#Baths_Basement(wlwo bath)_Garage Site Built Deck:_ On Frame_OR Frame
(Is/ the second floor finished?( 1 yes ( )no Any other site built additions?(_)yes ( )no
Ilr Manufactured Home: x'SW_DW_TW(Size 7O x IY )#Bedrooms. cit Garage: (site built?_)Deck: (site built?_)
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:ft Rooms: Use: Hours of Operation: #Employees:
U Addition/Accessory/Other(Size x )Use: Closets in addition?( )yes ( )no
Water Supply: yr/County Existing Well New Well(ft of dwellings using well )'Must have operable water before final
Sewage Supply: 1/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?LIZ yes (_)no
Does the property contain any easements whether underground or overhead(_)yes ( !1 no
Structures(existing or proposed):Single family dwellings: Manufactured Homes: ecify)
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Required Residential Property Line Setbacks:CComments: ` C` . `�/Tzs
Front Minimum J Actual 555+ 1 'CtT s-�✓`-" Y `
Rear ' a�'T5
Closest Side l V O(LO
Sidestreet/corner lot
Nearest Building
on same lot
Residential Land Use Application Page I of 2 03111
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: I 08 F .Via r*",* h a A o l+ on
F. . {Trani-- S{ -}nu)(Tref 5 1&- - -h� n r i Ciln+ oniro 5 Mai 0S5.
0..n r‘C9,Vri 6,n413 l 15 -U?1 nX3. ,3 n1; � Tr,
s5 ,rleV+ onto I e SIte nn pbe1I
die L ,� rr lrh) Ak m rii; e Circle -I e -rhe 2nd ex-4'4- am s+cam
Cn IeSIi-e Campbell 'Ave ( 7(&f±) Ext + 4he -}m-4'rc CtICl-e on 4,3 Leblle_ _
nenph4111 4c 10, IrY;,le) Fk+ Ih-e }rai e CI re] yoke the 2nd eK;+l1
.l - ra ()•(-10' • •e 6 1-a ' 3. u ; le j
Turn le{+ pr' Ebenezer Church h .cmi f5 lLvn r,gh+ onto ¢51us iZU
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 foregoinstatements are act to an nett to the best of my knowledge. Permit subj ct to re ocation if false information is provided.
.an'cwr , 0icv 31
Signature of Owner or Owner's Agent • Date
**It Is the owner/applicants responsibility to provide the county with any applicable information about the subjectproperty,including but not limited
to:boundary Information.house location,underground or overhead easements,etc.The county of its employbes are not responsible for any
Incorrect or missing Information that is contained within these applications."' '
'`This application expires 6 nfenths from the initial date if permits have not been issued"
•
Residential Land Use Application Page 2 of 2 03/11
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NAME: t r I( t�'(oCrL 5 APPLICATION#:
*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 1 CONFIRMATION#„5#\ Environmental Health New Septic SystemCode 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 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 recording for proof of request.
• Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
r 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 recordina 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_I Innovative 1�I f'tmventional I—I Any
I—I Alternative I-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 A'TT'ACH SUPPORTING DOCUMENTATION:
I_I YES Ii.!'1QO Does the site contain any Jurisdictional Wetlands?
(YES { --TN° Do you plan to have an i¢igation ysstem now or in the future?
I—LYES L�I-NO Does or will the building contain any drains'!Please explain.
I YES I fo Are there any existing wells,springs.waterlines or Wastewater Systems on this property?
t_IYES (�'NO Is any wastewater going to he generated on the site other than domestic sewage?
I—!YES 1,44:10 Is the site subject to approval by any other Public Agency?
(_)YES I,-I''�1(0 Are there any Easements or Right of Ways on this property?
IYES (�rv0 Does the site contain any existing water,cable,phone or underground electric lines?
If yes please call No Cuts at 800-6324949 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 Properly Lines And Corners And Making
The Site Accessible So That A Complete Site F.val m Cun Re Per(tmm 3
13'' 17
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PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/111
Date: 3/3-11901-Th Application#
PROCEDURES AND GUIDELINES FOR MANUFACTURED HOME INSPECTIONS
C/- �� y c 1_ _ VRA-20R& RA-20M Certification Criteria
L .I"IC'1�Q ,lIX'A RL, understand that because I'm located in a RA-20R or RA-20M
Zoning 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.)
24"Minimum ' " '`� p-Shaped 24°Minimum Rounded
Roof Pitch Rite --- <�• yyV ,;. Roof Pitch Rise •
I `
03/13x2006 - -
Note: Most Rounded Roofs Will Not Meet The Roof Pitch
Requirement As Illustrated. The Measurement From The Peak Of
The Roof To The Base Line Of The Roof Must Be 12" For Every 7'Of
Total Width Of The Home. (Ex: 14' Wide Home =24" Roof Rise)
Continued..........
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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4. The home must have been constructed after July 1° 1976.
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Signature of Property Owner/Agent Date
• By signing this form the owner/agent is stating that they have read and understand the
information on this form.