DOCUMENTS Initial Application Date: 4/ - /9 - /7 Application# 1 1 SCZ 4 i ci
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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.hamett.org/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
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LANDOWNER: '�i.4'11
i CCL(d Ili/1 AA:19 Mailing Address: d/ 7 / 4/4.11 I ,LGt ri L
City: L , Y\1J 4.4 State: u L Zip:2 G Contact No.(5/ fi/13-D3SOJ.Email: N 1 A
APPLICANT*:PA.t thjp 4- btu'.1 Mailing Address: ` Q.I5 4' y, Lie
City: l-i i,r\ State:N L Zip2.11.9r Contact No:Cq t Y3 W-42I3(oS- Email: 1 V I if
'Please fill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: Phone#
PROPERTY LOCATION:Subdivision: ' ^. n Lot#: Lot Size:3 4' S I JC
State Road# Stater- Road Name:_. C4 ��h �'\X.... Map Book&Page:
Parcel: k b'�-�,S b a.o L n e PIN: CSSS —1 1 1 3G5 A i 000
ZoninP iFlood Zone: X Watershed:�A Deed Book&Pag $ /,f p Power Company':
'New structures with Progress Energyyaas service der need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
1 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(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
c Manufactured Home:_SW tiDW_TW(Size /V x a 10)#Bedrooms:J Garage: site built?
g ( _)Deck: (site built?_)
C't -i' ll-CCIL6LAvt fr
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit: 1 1\
O Home Occupation:#Rooms: Use: Hours of Operation: #Employees:
O Addition/Accessory/Other:(Size x�Use: Closets in addition?(_)yes (_)no
Water Supply: 114 County Existing Well New Well(#of dwellings using well )*Must have operable water before final
Sewage Supply: New Septic Tank(Complete Checklist) DI 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 (_)no
Structures(existing or proposed):Single family dwellings: Manufactured Homes: Q.� Other(specify):
Required Residential Property Line Setback : Comments: ` p \G
Lk-
Front Minimum Actual et _
Rear o J4- --bi.
Closest Side IP Ln ane
SidestreeVcomer lot
Nearest Building _is El
on same lot
Residential Land Use Application •tM 1 • 2 /6 i I ` • 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINNGTON: Fro/4 Z:1/(/nrjr/Qh Jut/ h oil /ft,.7 60/,
-or- G. 20 /leS . /lteh I-itrh r,"c}iIt oh to✓/Z 41ci'J( /�-4 s Rd, /-41-
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0•�S •vttle_s, !R k is} iST r on fo k/ -e Rd. 1v ',.37 ntr/ _s . /!�rh j'.�4`'f.
040 /✓tIt Lkcgs Rd. -tor 0 ,23 mi ties.. T Ire 7qP -1s4 i^�'`if' o A 'h) _.77,--q;.,4 Loi,
for 0tO Al;les . OP-7 ZSy . L, . /S on Tfte 44 qT ire eh 01 pi.4eof ye t
cove To -eor f-r< ,
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 foriiyoing statements are ccurate and corre t to the st of my k edge. Permit subject to revocation if false information is provided.
azSignatur f ner or Ow is Age t Date
**it is 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 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"
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Residential Land Use Application Page 2 of 2 ' • 0 3i1 1
NOT FOR LEGAL USE
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NAME: // *Chge/ ¢ De✓rh Att17 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#
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 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 lid back 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 & 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(sl: can be ranked in order of preference.must choose one.
{_} 'Accepted {_} Innovative } Conventional (_} Any
{_} Alternative {_} Other
The a'plicant shall • 'the local health depart nt upon ubmittal of this applicatf in if any . the following apply to the prope•y in
questi n. If the a .wer i "yes",applicant MU` ATTAC' SUPPORTING DO'UMENTA ION:
(_} ES ( , NO oes the site contai' any Jurisdicti nal Wetlands?
(_} S ( }NO Di you plan to hay an'ii•. .o, s_ • to now or in e future?
(_} ES ( }NO Do-s or will the b lding contain any is?Plea•e explain.
{_I .ES _)NO Are here any exi ing wells,springs. 'aterlines or Wastewater Systems o this property?
{_} S _} NO Is an wastewate going to be generates on th- site other than domestic se ge?
{_} I {_} NO Is the s to subjec to approval by any oth- P.clic Agency?
{_} S {_} NO Are their: any isements or Right of Ways on this property?
(_} ;S {_} NO Does the st - ontain any existing water,cable,phone or underground electric lin-
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 S i •ly Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site Acce 'le o T t A Complet to Evalu4 n Can B• 'erformed.
I '4 , q -/9 -
'(:) PR• ' RTY OWNER OR O� NERS LEGA RE' • `ham TATIVE SIGNATURE(REQUIRED) . DATE
10/10
Date: (41 3.0 ) Application#
PROCEDURES AND GUIDELINES FOR MANUFACTURED HOMES
Replacement & Removal Criteria
I, \.--cr d nAkkrki,do hereby certify the following:
(Print Name
1. That I own a tract of land located on SR C4 .► i1t an RA-30 IRA-40 or RA-20R/RA-20M
district which has a functional septic tank;
2. That the existing single/double-wide manufactured home is to be removed or was removed on
"'iii liC2. (date)
1
3. That I am replacing an existin:double wide manufactured home with a single/ uble wide
manufactured home,and: nn
4. That the replacement of this manufactured home creates P residence(s)on this single tract of land,
and;
5. That there will bep.... manufactured home(s)on this single tract of land and I do/do not own
property within 500 feet of this tract that contains a manufactured home.
6. 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 A-Shaped 24"Minimum 24 Rounded
Roof Pitch Rise L- -- - Roof Pitch Rise X
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l4 in Width�
14' in Width
03:13 2008 -- 77-.-
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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
7. The home must be underpinned,the underpinning must be designed for manufactured homes&
installed in good workmanship-like manner along the entire base of a manufactured home,except for
ventilation and crawl space requirements,and consisting of the following: metal with a baked—on
finish of uniform color;a uniform design and color vinyl;or brick,cinder block,and stone masonry as
well as artificial stone masonry. -
8. The home must have been constructed after July l r 1976.
9. The homes moving apparatus'removed,underpinned or landscaped.
I Select One of the Following Options Below:
a. The current manufactured home will be removed prior to the Zoning Inspection.
. . _ The current manufactured home,is scheduled to be removed through Project AMP!
c. The current manufactured home will be removed after the final inspection has been performed and
the certificate of occupancy has been issued.(Additional Fees& Requirements Shall Apply)
*(Additional Information for Option C)Temporary approval for replacement of a manufactured home is
allowed only under the procedures and limitations stated below.
Please initial next to each item to indicate that you understand and have or will comply with as necessary.
1) A valid manufactured home moving permit must be submitted for the removal of the existing home located
on the property.
2) A copy of a Bill of Sale or a Title Transfer of the existing home must be submitted.
3) Items 1 &2 must be submitted to Central Permitting prior to your permit issuance.
4) Property owner/agent acknowledges that due to the fact that a second zoning inspection is required,in
order to facilitate this request,a re-inspection fee in the amount of fifty($50.00)dollars shall be paid
during the permitting process.
5) Once the home has met all other zoning requirements,a temporary approval shall be granted in order
to proceed with obtaining a certificate of occupancy. From the date the certificate of occupancy is issued,
the property owner shall have five(5)business days to remove the pre-existing manufactured home.
6) Property owner/agent acknowledges that if the pre-existing manufactured home is not removed by the
specified time of five(5)business days that he/or she shall be in direct violation of the Harnett County
Zoning Ordinance. And by creating a violation of the Harnett County Zoning Ordinance shall subject
themselves to enforcement actions,penalties,and fines specified within Article XV,(Administration,
Enforcement,and Penalties)of the Harnett County Zoning Ordinance. Each day the violation continues is
a separate offence and is a misdemeanor punishable by a fine not to exceed one hundred($100.00)dollars
or imprisonment not to exceed thirty(30)days.
7) Property owner/agent acknowledges and affirms that the guidelines,procedures,and requirements
associated with the replacement of a manufactured home and the penalties for creating a violation of the
Harnett County Zoning Ordinance have been explained and accepts this document as an initial notice of
violation.
40.-.A.. .; 2-0..-).-5-
Signature ilfProperty Owner Date
*By signing this form the owner/agent is stating that they have
read and understand the information on this form