LAND USE R Initial ApPilntion Date: - I ry 1J-A/ l y1/ I10 tU� (/Slc
L441-7 V . Ct�' Application p VVV/// 1
1 ' c LINTY OF HARNETT RESIDENTIAL LAND USE APPLICATION CU#
central Permitting 1E.Fm Street,Lillington,NC 27548 Phone:(910)893-7525 ext:2 Fax:(910)8932793 www.harnettorg/permits
"A RECORDED/ SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER:� _Sr� -boss , ?c,,ab U'(A� Mailing Address: R(c��S C{1-1-4-Ly U-Jc3 0-
City I k:Jkc State: Zip:a�Calcontact No:Cl/9 -sr IQ K -1.34)9 Email: �Ja2N 3�U7/ Le & I41.4,.,,(
APPLICANT': Aa-Ic LPs. Ma!IinoAddrewew .�fcs espA-4-4 LO cr-
City, Cr; State7VC Mix;IV-(Contact No:t7(C/-8081307 Email: Gavel 'F'bGZ/!r (Ill 4ri/_C.riy
'Passe fill out applicant Information II different than NMowner
CONTACT NAME APPLYING IN OFFICE: DQei r �lu(la/3ad Phone# 9/9-84/8- ?JO
PROPERTY LOCATION:Subdivision:�P F6R f likief As L '`3 LotMSizze:.'
Ad
State Road# State Road Name:,I i - -6, 6 • / ,, Q000kk&&Pagel:?Doss'
/ a.114
Parcel:(}/I^/�1'�t0 LOCI I L It2) PIN: Oco -- , h - -Il.L 1 `COtJ 4-3,
Zoning:' �' Flood Zone: Watershed: Deed Book&Page: S3 Ci/ , Power Company: C(
'New structures with Progress Energy as service provider need to supply premise number 759 ere 9c0 / from Progress Energy.
PROPOSED USE: .L
❑ SED:(Size S}x �., 7 —Monolithic)#Bedrooms: #BaNs:_Basemant(wlwo bath): Crawl Spara:_sleb: Monod
(Is the bonus morn finished?(J yes (__)no wl a closet?(_)yes ( )no(N yes add In with#bedrooms)
❑ Mod:(Size x )#Bedrooms #Bets_Basement(wlwo bath) Garage:_Site Built Deck: On Frame Off Frame_
IIs the second floor finished?(J yes ( )no Any other site built additions?L yes (_)no
❑ Manufactured Home: SW DW TW(Size x )#Bedrooms:_Garage:_(site built?_)Deck: (site built?_)
❑ Duplex:(Size _)No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use: Hours of Operation: #Employees_
❑ Add18oNAccessory//Other(Size x )Use: Closets In addition?(J yes (__Ino
Water Supply: /C_.ounry _Existing Well _New Well(#of dwellings using well )*Must have operable water baton 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(5004 of trap listed above?(_)yes (1flb
Does the property contain any easements whether underground or overhead(___)yes LYtr
Structures(existing or proposed):Single family dwellings: Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments;
Front Minimum 3S Actual (/.-
Rear ?S 137
Closest Side (1) 2
Sidestreet/comer lot
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINOTON: Z/ Ir/ ' 1 v` `7
MAU al
If permits are granted I - ^con• to all •rdina -s and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state g'1 ...are -s ,.//-•y�� In
and correct to the st of my knowledge. Pernik subject to revocation If false information la provided.
81g r or.OwMre Agent Dab
"It N 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 ere 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 Issued"
Residential Land Use Application Page 2 of 2 03/11
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NAME: APPLICATION#: v�' ��
1
'This application to be Oiled 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) 'y, �(}-
910-893-7525 option I
I Environmental Health New Septic SvstemCode 800 CONFIRMATION# I q D I A T I V I
• AU 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 al/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 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 olven at end of recording for proof of request.
• Use Click2Gov or IVA to verify results. Once approved, proceed to Central Permitting for permits.
U Environmental Health Exlstlna 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 lid beck In place. (Unless Inspection Is for a septic tank In a mobile home park)
• DO NOT LEAVE UDS OFF OF SEPTIC TANK
• After uncovering outlet end call the voice permitting system at 910-893-7525 option 1 8 select notification permit
it multiple permits, then use code 800 for Environmental Health Inspection. Please note confirmation number
. v:n ..t : • •f : • al• -. .
• 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 deysystem type(s): can be ranked in order of preference,must choose one.
(_I Accepted (_}Innovative (_} Conventional 1_1 Any
I_) 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:
I—IYES ( /NO Does the site contain any Jurisdictional Wetlands?
(_LYES (11,NO Do you plan to have an jaipation system now or in the future?
{_}VES { 710 Does or will the building contain any mina?Please explain.
I—IYES ILi 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?
I-I YES I1/1/ NO Is the site subject to approval by any other Public Agency?
(_)YES ( O Are there any Easements or Right of Ways on this property?
(_}YES ( O 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 modals Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I Und� T t I o y Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
•ommppleette/Site� Evaluation Can Be Performed.
rj L /�-7Gl _/o„
P•OP:RTY 0 ' 'S OR 0 R LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
U 10/10