DOCUMENTS Initial Application Date. I ) (� ` ) 1 7 Application b I giSo cLA- l aa.a
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION CLIP
Central Permitting 108 E Front Street LiltingIon,NC 27546 Phone(910)893-7525 ext 2 Fax (910)893-2793 www.harnetiorg/permits
"A RECORDED SURVEY MAP.RECORDED DEEDI (OR OFFER TO PURCHASE)8 SITE PLAN ARE GREQUIR1E DD WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNERr :' 1IIrl91l✓� u71AY)fl(' `\I(I1\ , y1 Mailing Address: 271 /`Pili)ii-iw d Li/
city1ota I \(kiwi 6 state AC- Zip. G"15thcontact No. Email:
APPLICANT': Mailing Address.
PlState.
ease Nl out applicantnformation l different thanlZp Contact No Email.ndowner '.
CONTACT NAME APPLYING IN OFFICE: 1 � N Phone k S LOC)PROPERTY LOCATION:Subdivisan: S DO 4n 4.1( �A/IR4S Lot k'. ILot Size. OI _ r'�
Stale Road/�IXr, Cis,4` / State Road Name. �J1/ ,,']CS wO(1J 1r . (-0
r� Map Book&Pager cYr/7 ILn
Parcel J * bUsS3 f-cri f�' [Y' PIN: O O�S3�r—� -0Lo — (cfl ( OS`• Uot
Zonin loud Zone. y Watershed`-'c' Deed Book&Page:�3`(Q/'`CS Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy
PROPOSED USE:
LISFD.(Size x )A Bedrooms._b Baths:_Basement(w/wo balh)._Garage:_Deck._Crawl Space._Slab._sllaboluAi.
Os the bonus room finished?( )yes ( )no wi a closet?( )yes (_1 no(if yes add in with k bedrooms)
LI Mod (Size x Id Bedrooms it Baths_Basement(w/wo bath) Garage Site Built Deck_ On Frame Off Frame_
Is the second foor finished?( )yes ( Ina Any other site built additions?(_)yes (_)no
❑ Manufactured Home SW DW_TW(Size _111 Bedrooms._Garage (site built?_)Deck:_Isite built?_)
❑ Duplex:(size x )No.Buildings No.Bedrooms Per Unit
❑ Home Occupallon.N Rooms- 9 Use. (Hours of Operation'. #Employees_
WIZ Addition/Accessory/lithe,(Size ZI x )Use: 1`Fb)CDM/' 9✓✓L'VIO` L.Ml YV11P� 1500 I Closets in addition?( )yes (�no
Water Supply: L./ County _Exsting Well New We (11 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 vac(of land.own land that contains a manufactured home within five hundreddrfeel(500')of tract listed above?(_)yes (/no
Does the property contain any easements whether underground or overhead(_I yes ( ✓)no
Structures(existing or proposed) Single family dwellings. Manufactured Homes Other(specify).
Required Residential Propels) Line Setbacks: Comments:
Frons Minimum 1 l Actual
Rear SaS Al-PICS Closest Side I C
Sidestreel'corner lot „.--_—_--
Nearest tlding t 3 litsss( '51-
—
on same lot
lend osnppilcalipn —tJ , nW`nw Iolz 03�11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Nn:WI on 40. 647IA 1-e' P115 1.,Mrx]
Tr. 754 Mti31wc»rl Tr nA RI-p.;-
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If permits are graveI gree to conform to all ordinances and laws of the Slate of North Carolina regulating such work and the specifications of plans submittedI hereby state that fo of s laments are ra NJ correct to the best of my knowledge Permit sub' t to rpvocation if false information is provided.
a 4 1-T }
Si ure of Owner's Agent Date
e •
"'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 Jmployees are not responsible for any
Incorrect or missing ipformatlon that is contained within these applications."'
"This application expires 6 months from the initial date if permits have not been Issued"
Reside¢,&I and Lice Application Pagc 2 of fYt'I
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NAAIP;: r ; J' 1 fl I°Us APPLICATION 41:
*This application to he filled out when applying for a septic system inspection.*
County Health Department Application fir Improvement Permit and/or Authorization to Construct
II'THE INFORMATION IN THIS APPLICATION IS FALSIFIED,CHANGED,OR THE SITE IS ALTERED.THEN THE IMPROVEMENT
PERMIT OR AIrfIIORIZATION TO CONSTRUCT SHALL BECOME INVALID. The permit is valid for either MI months or wirhoot(spimfmo
depending Lanai ducuuIFlllxllnn.uhntinetl Wimple—hi site plan_M)months.Complac plat=without espoahtm
910-593-7525 Option I CONFIRMATION#
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 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 lo 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.
• Alter preparing proposed site call the voice permitting system at 910-893-7525 option 1 to schedule and use code
BOO (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 properly.
• Prepare for inspection by removing soil over outlet end of tank as diagram indicates, and lift lid straight up Of
possible)and then put lid back In place. (Unless inspection is for a septic tank in a mobile home park)
• DO NOT LEAVE LIDS Orr 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 audsuri ration m consouct please indiale desired system Iypeb): can he ranked in order of preference,must choose one.
I_ I Accepted I. I lnntnative I—I Conventional I—I Any
1I Alternative ii 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(utsner is yes'.applicant MUST ATTACH SUPPORTING DOCUMENTATION:
{ I YES I—I NO Does the site contain any Jurisdictional Wetlands''
I—}YES I— NO Do you plan to hive an injoatiga system non or in the future?
i—I YES I_( NO Does or will the building contain any dritlm.'Please explain.- _
I _I YES I INO Are there any existing wells.springs. waterlines or Wastewater Systems on this properq"
I__I YES i—I NO Is any wastewater going to he generated on the site other than domestic sewage?
i—I YES 1—I NO Is the site su hjeci to approval by an) other Public Agency?
I—}YES LI NO Are there any Easements or Right of Ways On this property?
I— YES I_ I NO Does the site contain any existing wmar.cable. phone or underground electric lines?
If yes please call No Cuts at 8(1(-632.1949 to locate the lines. This is a free sen ice.
I Haw Head This Application And Certik Thai The lnfirmation I'to'ided Herein Is True.Complete And Correct. Authorized Clmnb Mid
State Officials Are Granted Right Of-mita To Conduct Nece.ssar) Inspections To Determine Compliance With Applicable Laws And Rules.
I Understand That I Am Solely Responsible For The Proper Identification And labeling Or All Property lines And Corners And Making
T e Aµlssihle So That A Com! "lc Evaluation Can Be Performed. �,
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P OPERTY/IWNERS OR OWNERS LEGAt.REPRESENT.ATIVE SIGNATURE(REQUIRED) AT .
I WIG