DOCUMENTS Initial Application Date: J 13) I / Application I 1 WC- a I . S
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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 snmAnharnett.org/permits
"A 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: 3 Onin Be FfrIn(tee" Mailing Address IOV NC a 1 E---
city,
City: L111 )111 .- )f1 State:Nc Zip.2754 IT Comae No: 31c-'117- 2131 Email. 5O10• c ke1'I'In �r Q,r� C h Pvi-{r
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APPLICANT': t vvit 1'vswC, Mailing Address: l'6(;)- 4z45cn X24
City 11-1- �
C`il1 state:AA Zip: SZ ontact No: q 1 9 g04Z
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•Please fill out applicant information if different than landownera [��-f Q
CONTACT NAME APPLYING IN OFFICE:
�/�tn0.h V �'� �GlS LUQ Phone Q ( 9 - `� `"�v5T/?
PROPERTY LOCATION:Subdivision: I ' 1Tr , S.. Lot#: �J Lot
ySize:ase 6a'r7••C-.
State Road 4 P' -01•1 &StateStRoad Name: A..�' /3. R. 7tN � �j '1 Map Book
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Parcel: c)-1 bYOQ ea bi-1 1 OS PIN.
PIN. I..QQNLLrvtlr0 -- /O-/[- 4 V I c V W
Zoning� e4OFlood Zone: � Watershed:A 1 Deed Book B Page3 WI / .Dc Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD'.(Size x )4 Bedrooms: #Baths:_Basement(w/wo bath): Garage: Deck:_Crawl Space: Slab. Slab._
Is the bonus room finished?( )yes ( )no wf a closet?( )yes (_)no(if yes add in with#bedrooms)
❑ Mod:(Size_x )4 Bedrooms_#Baths_Basement(wlwo bath) Garage:_Site Built Deck:_ On Frame OR Frame_
(Is the second floor finished?(_)yes ( )no Any other site built additions?(_)yes (_)no
❑ Manufactured Home SW_OW_TW(Size x )4 Bedrooms:_Garage: (site built?_)Deck. (site built?—)
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation.#Rooms: //yy Use: Hours of Operation' 'n #Employees:
Addition/Accessory/Other.(Sir%) )Use: C�'�A�h�L Closets in addition?(_)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 Nat 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
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Structures(existing or proposed):Single family dwellings: \e'F I Manufactured Homes: Other(specify): ' I
5FD 1 relor,
Required Residential Property Line Setbae6
Comments:
Front Minimum ;CI Actual/ `x .
Rear 1t 1 S
Closest Side
SidestreeVcorner 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 LILLINGTON:
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 forego ng statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
ac � �fa� te
8 atureot Owna`r of Owner's Agent Date
"it Is the ownerlapplicants 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 applicbtibns."•
**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 03/11
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NAME: 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 properly 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.
• It 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 Ild,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 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 recording for proof of request.
• Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting for remaining permits.
SEPTIC
If applyin, for authorization to construct please indicate desired system typets): can be ranked in order of preference,must choose one.
LI Ace Ned i—I Innovative I_1 Conventional IJ Any
i—I Alte mtive I-1 Other S
The applica t shall notify the local he.. h departm• t upon submittal of this appli alio if any of the following apply to the troperty in
question. If he answer is'yes",appli ant MUST • TTACH SUPPORTING I CU ENTATION:
l_)YES _I NO Does thi site contain any urisdictional Wetlands?
IIVES _l NO Do yo plan to have an irti anon s sem now or i the future?
i-_IVES I NO Doe. or will the building c • lain any dmia !P16 se explain. —_
I YES { I NO Ar' there any existing wells springs. waterline or Wastewater Sy. ems on this property?
1_IYES I 1 NO I-any wastewater going to b generated on thi site other than dome••is sewage?
1—I YES I } NO s the site subject to approval by any other P 'tic Agency?
I I YES I } NO Are there any Easements or Rt•ht of Ways n this property?
1—IYES I NO Does the site contain any existi - water. able,phone or underground electric '--.'
If yes please call No Cuts at 800 1 '49 to locate the lines. This is a lice 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 Acc tion Can Re Performed. 5/ ///
PR AL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/1U