LAND USE •
Initial Application Date: .12 Ul 2 — f0 Application.. ..,/ 0 5 • 25 _ 705
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION CU
Central Permitting 108 E. Front Street, Llllingion, NC 27546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.harnettorgtpermit;
LANDOWNER: Liolt _ a aIl.l,fa a • Mailing Address: (0 5) 0 1 Lym
City:
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/�i fin F t � Stat e:_LL�IP: � "J{ )- al4S
APPLICAN �ta e T�n` #:
' la I Si - I. Mailing Address: ynei I l
City: Ml , r 11 Pte.. State: Ne.ZIp:C _4Hlome. #;Q I J - 9� 't rrvewact #:
`Please fill o .plicant information If different than landowner _
CONTACT NAME APPLYING IN OFFICE: rn t of @ 1 Pity se: Phone #:. It - 'lam- n L( 3-3- 5
PROPERTY LOCATION: Subdivision: OY` Lot it' L -/,
7 Lot Acreage: o :�i • State Road #: St IN l \ State Road Name: t 4 Inn 1 �� 51 eta C t - • - Map Book&Page: Qoci J , �a 7t-f
Parcel D n 7 S/ S ��, "!' , O b j PIN: � � Cl 1 J- 76 -i.R / r -. bO c J
Zoning:',{} ^ aoR, Flood Zone: N /) Watershed:. b4 l Deed Book &Page: Q2S 3 3 / lI a C )Power Company:
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON;
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PROPOSED USE: (Include Bonuaro a bedroom If it has a clos t) 'y/ rcle:
O SFD (Size y gx 3 6) # Bedrooms :3 # Bath2• 5 Baserent (w /wo bath) NI* Garage y Deck / - Crawl Space / Slab •
❑ Mod (Size x ) # Bedrooms_ # Baths_ Basement (w /wo bath) Garage Site Built Deck ON Frame / OFF
❑ Manufactured Home: __SW _DW TW (Size _x . ') # Bedrooms Garage (site built? ) Deck (site built? )
❑ Duplex (Size x ) No. Buildings No. Bedrooms /Unit
❑ Home Occupation # Rooms Use Hours of Operation: #Employees
❑ Addition/Accessory/Other (Size _x ) Use - Closets In eddltlonLiyea f )no
'Homes with Progress Energy as service provider need to supply premise number from Progress Energy
Water Supply: ( County (J Well ' (No. dwellings, ) MUST have operable water before final
Sewage Supply: t&) New Septic Tank (Complete New Tank Checklist) (_j Existing Septic Tank 1 ) County Sewer
Property owner of this tract of and own land that contains a manufactured home wM five hundred feet (500') of tract listed above? OYES UNO
Structures (existing or proposed): Single family dwellings ye .S Manufactured Homes Other (specify)
Required Residential Property Line Setbacks: Comments: r -
Front Minimum 3S Actual 31.0
Rear Ls -J
neat Side 1 () - u ' 0
C destreet'comer lol �-
Nearest Building 1 el
on same lot
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 submitter
I hereby state that oregoln r statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false Information is provided.
Signature of Owner or Owner's • : =tit Date c�( ,. U
_
"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
LAND USE Please use Blue or Black Ink ONLY -
. 4/08
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NAME: ta 0 1 I S 1/‘1I. t„:NrCI APPLICATION #:
*This application to be taled 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 I CONFIRMATION #
❑ Environmental Health New Seale System Code 800
• 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 properly 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.
• Call No Cuts to locate utility lines nrior to scheduling inspection. 800 - 632 -4949 (This Is a free service)
• 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 CIIck2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
0 Environmental Health Existing Tank Inspections Code 800
• Follow above Instructions for placing flags and card on property.
• Prepare for inspection by removing soil over door as diagram indicates. Loosen trap door cover- (Unless
Inspection is for a septic tank in a mobile home park)
• After preparing trapdoor call the voice permitting system at 910 -893 -7525 option 1 & select notification permit it
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 pleas* indicate de ired system type(s): can be ranked in order of preference, must choose one.
(_} Accepted {_) Innovative 1 } Convention] {_) 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 {si) NO Does the site contain any Jurisdictional Wetlands?
(_)YES {N) NO Do you plan to have an jrrieati0ASystem now or in the future?
{_ }YES {N) NO Does or will the building contain any drautpp? Please explain.
{ — IYES iL } NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
{N,} NO Is any wastewater going to be generated on the site other than domestic sewage?
{_)YES NO Is the site subject to approval by any other Public Agency?
(_)YES Ni.) NO Are there any easements or Right of Ways on this property?
{_ }YES Ni.) 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 Be Performed.
/7 3 �l
PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) HATE
5/08