LAND USE Initial Application Date: /Z _ •l - ` ° Application # 579 h V
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lilliin / gton, NC 27546 Phone: (910) 893 -7525 q Fax: (910) 893-2793 www.harnett.org
LANDOWNER: j Pall Po / �1.y Mailing Address: 6/27 Ms, NC 2 �y
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City: Ccvit J State: /Y L ZIp: G /.J2! Home #: 919 994 R6 `L 4 0 �
Contact #: q 1 -1 O J A31 OW
APPLICANT *: than 13, J1ldenc L.LC y Mailing Address: 8 : 4 N7
City: Coca' State: NC Zip: 21.521 Home #q17 4 574 d .1 Contact #: - i 19 524 585.2.
* Please fill out applicant information if different than landowner I C_
PROPERTY LOCATION: State Road #: 2 { State Road Name: Miaku 27 GL{d,r •
Parcel 7 4a ,9 J o 5 PIN: Te -• 761-4044, . 7
Zoning: 1 i '4 0 Subdivision:. n o Lot #: ! Lot Size: 2.937
Flood Plain: .4 Panel: Watershed: iii/ p
✓ Deed Book/Page: 1 9 78 95A Plat Book/Page: LSD 2 - 7,74 - ?
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: N C 7.7 east' 74) 1 Qcl7& riensc'
It &vol• j 55 9n l e lo miles am /e_'t4
PROPOSED USE: Circle:
❑ SFD (Size_x Bedrooms_ # Baths Basement (wlwo bath) Garage_ Deck Crawl Space / Slab
❑ Modular. On frame _Off frame (Size _x ) # Bedrooms # Baths Garage _ _(site built ?' Deck (site built ?)
O Multi - Family Dwelling No. Units No. Bedrooms /Unit
O Manufactured Home: _SW DW TW (Size x_) # Bedrooms _ Garage (site built?_) Deck (site built ?_)
❑ Business Sq. Ft. Retail Space Type # Employees: Hours of Operation:
❑ Industry Sq. Ft. Type # Employees: Hours of Operation:
L"
❑ Church Seating Capacity . # Bathrooms Kitchen
❑ Home Occupation (Size x ) #Rao s A^ Use Hours of Operation:
/ J l +( \ / Accessory/Other (Size 30 x 4 0) Use f7a7t _
❑ Addition to Existing Building (Size _x_) Use Closets in addition(_)yes (__)no
Water Supply: (County (__) Well (No. dwellings ) ( ). 0 r
Sewage Supply: aw Septic Tank (Must fill out New Tank Checklist) . Existing Septic Tank (—) County Sewer (_) Other
Property owner of a tract of land own land that contains a n7nufactured home w /in five hundred feet (500') of tract listed above? (_)YES (4i)40
Structures an this tract of land: Single family dwellings Y Manufactured Homes Other (specify)
Required Residential Property Line Setbacks:
. Comments:
Front Minimum 35 Actual IQtt-
Rear 25 ( idh '
Side 1Q_
Sidestreet/comer lot 20
Nearest Building 10
on same lot
If permits are granted I agree to conform to all ordinances and the laws of the State of North Carolina regulating such work and the specifications of plans
submitted. I hereby state that the foregoing statements are accurate and correct to the best of my knowledge. This permit Is subject to revocation if false
information is provided on this form.
1rILGC d 4w dui den /Z -2 - ZOO
Signature of er or Owner's Agent Date
"This application expires 6 months from the Initial date if no permits have been Issued"
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
Please use Blue or Black Ink ONLY
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NAME: APPLICATION #: /V 5 2 7 1.13
*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 1S 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 System 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
0 2(I/ 7
• 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 Pack 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 applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference, must choose one.
{_} Accepted {_} Innovative { Conventional {_} Any
( 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:
{_)YES {_) NO Does the site contain any Jurisdictional Wetlands?
{ { NO Do you plan to have an on�syster now or in the future?
{_)YES { _} NO Does or will the building contain any drains? Please explain.
( I — NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
{ (_) NO Is any wastewater going to be generated on the site other than domestic sewage?
( { NO Is the site subject to approval by any other Public Agency?
(_)YES i NO Are there any Easements or Right of Ways on this property?
(_)YES (_) NO 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 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 Complete Site Evaluation Can e P rtormed. il
A
. /Z 3 — /D
PROPERTY OWNERS OR OWNERS LEGAL REIiRES NTAAT VE SIGNATURE (REQUIRED) DATE
10/10
How to Properly Mark Property for Soil Evaluation
(MUST MATCH SITE PLAN)
. ink flag
1
i . iron
Pint flag -+ g° flag i
4•• • flag
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fiar
range /
Pink flag
iron it iron
ROAD
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