DOCUMENTS Initial Application Date: LAI
I J' 1 ' 1 Application# I / x J 1 J t tic)
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.harnett.orglpermits
RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)8 SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
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LANDOWNER. aa/ac4 Zee_ /^
Mailing Address: )Orr ll*'6; - 11
City: Cao h Staa)te:Ak Zip. Contact No: Email:
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APPLICANT*: . Li ry oAy /741/40.1 Mailing Address: ///�aah�// 4,c 2,'f ���```"
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City: 41/Ar State:Ate' Zip:27jSContacl No: 9(0 ' 9By'4a9.'�L Email: z'7 .470' yetace9 tvai_
*Please fill out applicant information if different than landowner // o
CONTACT NAME APPLYING IN OFFICE: /M1dt/�/ �7• tCt yest'f Phone# 7/6 -- 98V- 6,32 •
PROPERTY LOCATION:Subdivision: 30Ss s46., IO 1* Lot#'. / ' 1 Lott
lU� Size:1
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State Road# StateRoad Name: -501-5015. 44/Le- • Map Book 8Pagep.+'l 14NI t�7
Pacel: lIvoI 113-^SV1 PIN: I t- 00a
Zoning: tlood Zone: X Watershed: /1..4 Deed Book 8 Page:3404f ,dQO
Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Size x )#Bedrooms: #Baths: Basement(w/wo bath): Garage: Deck: Crawl Space: Slab: Slab:
(Is the bonus room 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_OH Frame_
(Is the second floor finished?(_)yes (_)no Any other site built additions?( )yes ()no
❑ Manufactured Home:_SW_DW_TW(Size )#Bedrooms: Garage: (site built?_)Deck. (site built? )
❑ Duplex:(Size )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation: Rooms: Use: yHours of Operation' / #Employees
LY Addition/Accessory/Other:(Size 2$ x3/.4 Use: /r7/�D76.14'• jJ�4M. . 18 /4Y4 Closets in addition?(e)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(500')of tract listed above?( )yes ( )no
Does the property contain any easements whether underground or overhead(_)yes (lino
Structures(existing or proposed):Single family dwellings: ✓ Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:� \\` S ' e_ l ,r1 S\,,ON
mS 3 V Rk s
Front Minimum 3S Actual .1S+ \ CUD �a&R.SE' M. t elptvew Off. Li..z n/
Rear 190•'a. Icvc�(QI n o ar :A ad-SA
Closest Side IV 1S • I CA f�Aw11- 1w&n%-ttA^ �) -Phila./ 40t
SidestreeUcorner lot COTnI.4 ,�.A.t. 5 130S
Nearest Building ID%.-r t�'� �c.+U
on same lot Cl
Residential Land use Application TION
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APPLIC TIONC NTINU ON B 1�rt�
to c y-1 1043 a.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
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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 tements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
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tura of Owner ner' gent Date
"It is the owherlapplicants responsibility to prpvlde 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 issued"
Residential Land Use Application Page 2 of 2 03/11
Harnett County GIS
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April13,2017
SITE PLAN APPROVAL
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NAME: /(, /I. (.M1daJ 14.-re fGS APPLICATION#:
*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 1 CONFIRMATION#
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 pnderarowth 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 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 I 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 oroof of request.
• Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
Environmental Health Existina 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 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 Si 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 typetsI: can be ranked in order of preference,must choose one.
II Accepted I Innovative VI Conventional 1-1 Any
I Alternative 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:
I_I YES I,eI NO Does the site contain any Jurisdictional Wetlands?
II YES I YI NO Do you plan to have an irrigation sYstcni now or in the future?
I YES I/1 NO Does or will the building contain any drains'?Please explain.
IIYES I!I NO Are there any existing wells,springs. waterlines or Wastewater Systems on this property?
I (YES ILI NO Is any wastewater going to be generated on the site other than domestic sewage?
)YES I riel NO Is the site subject to approval by any other Public Agency?
IIVES I al NO Arc there any Easements or Right of Ways on this property
I ✓I YES I—I NO Does the site contain any existing wafer,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 Property Lines And Corners And Making
The Site Accessible So That A Co etc Site Evaluation Can Be Performed.
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PROPERTY OWNERS OR OWNS LEGAL REPti ITATIVE SIGNATURE(REQUIRED) DATE
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