DOCUMENTS Initial Application Date: - I(4- (1 Application# I / , 011-1 I ( ()Log
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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,RECORDE,D�D�EED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTINGp ��1 A LAND USE APPLICATION"
LANDOWNER:NA� &C'Ut4b �. rW+M1YT. Mailing Address: W 14.44 (ZA AntrY NL 2-7)� I
City: N'hya( SState:NL- Zip:11g#1 Contact No:- Email
APPLICANT: C'TAM( T F4W V wiabst 1` �nMailing Address: 14ye% taU M -— St•
city L.IlL/W kaM Stab: N(- Zip: ilSMttontact No: C1ib- Lv3 314mail: CShe Ata, shb C er.1 cin
'Please fill out app tinformation if landowner
different than landowr /
CONTACT NAME APPLYING IN OFFICE: Phone# rr11
PROPERTY LOCATION:Subdivision: .-I�_ Lot#: J' Lot Size:S-3 A
State Road# el]
State Road Name: CY]L.i1 tie C{R4(CM R4 Map Books Page:2C IC / 2S1i
Parcel: Del] It (X) U ]43 PIN: 1..0 Co • at.: - 11x}7. coo /'
Zoncip(rCL\Flood Zone:/l Wabrehed'L' Deed Book&Page: 3.3'1 i /0 34,a Power Company: D9,11.0 IP > µ^U
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
4 # / — —Monolithic
SFD:(Size$C xS$ )it Bedrooms: Balhe:.3Baeement(wMro bath):_Garage: ✓ Dsold: Crawl Space: Sl
eb: Slab:
(Is the bonus room finished?(i ,yes ( )no wl a closet?(_)yes (J /no(If yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms_#Baths_Basement(w/wo 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 DW_TW(Size )#Bedrooms: Garage: (site built?_)Deck: (site built? )
❑ Duplex:(Size_x_)No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use: Hours of Operation: #Employees:
❑ Addition/Accessory/Other:(Size x )Use: Closets in addition?(_)yes (_)no
Water Supply: County —.Existing Well A. New Well(#of dwellings using well I )'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 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 OZ)yes ( )no
Structures(existingroposad) ingle family dwellings: / ,,JJManufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:.10 A.k3-4 t'"1r A+L.x-r¢ ��1 rite
Front Minimum 35 Actual I ___
Rear 111I,1 IIS -
Closest Side L,TII�
Sidestreet/comer lot
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONSTOTHE_ �' R
PROPERTY FROM LILLINGTON: EA Moil S Tie I fu V e eu,n 1 on
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If penes are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the speclhcations of plans submitted.
I hereby state that foregoing statements �antlco d to the best of my knowledge. Permit subject to revocation if false information is provided.
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Signature of Owner or Owner's Age 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"
Residential I and Use AppliTion Page 2 of 2 03'I I
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NAME: IICril-4t ficiew. Bu4tL6t )bc . APPLICATION#:
7 *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 I CONFIRMATION#
Environmental Health New Seo(IC SvstemCoda 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 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.
• All lots to be addressed within 10 business days after confirmation. $25.00 return trio 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 lank 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 Droof 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 he ranked in order of preference,must choose one.
1-1 Accepted 11 Innovative I Conventional (_I Any
1 ) Alternative 1-1 Other
The applicant shall notify the local health depanment 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:
1_1 YES 14 NO Does the site contain any Jurisdictional Wetlands?
I—I YES 1/NO Do you plan to have an irrigation system now or in the future?
IIYES ( ✓i NO Does or will the building contain any drains?Please explain.
II YES Iylit NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
I ES 1�NO Is any wastewater going to he generated on the site other than domestic sewage?
11— ES 11 NO Is the site subject to approval by any other Public Agency?
1/YES 1_IINO Are there any Easements or Right of Ways on this property?
1—)YES 1t[1 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
Slate 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 Accessi e ' that A Com tete Site Evaluation Can Be Performed.
7� 7✓/T���/ (p- IS-l1
PROPERT OWNERS OR OWNER CADREPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
Harnett County Department of Public Health
Well Construction Permit Application
If the information in the application for a Well Construction Permit is falsified,
changed, or the site is altered, then the Well Construction Permit shall become
invalid.
APPLICANT INFORMATION
Sire e Hcsst TJwtcLes, �n� C CIC ) gq2-t1 u1b19
Applicant/Owner Phone Number
1. t N NttA)% sr VlbnyhH k 9-ls'i4
Street Address, City, State, Zip Code
The Applicant must submit a Site Plan. The Site Plan is a map/drawing of the property and must show:
I.existing and/or proposed properly lines and easements with dimensions;
2.the location of the facility and appurtenance;
3.the location for the proposed well;
4.the location of existing or proposed sewer lines and/or sewage disposal systems within 100 feet or the proposed well:
5.the location of any existing wells within 100 feet of the property;,surface water bodies;
6.above ground and/or underground storage tanks:
7.and any other known sources of contamination within POO feet of the proposed well site.
The Applicant shall notify the Harnett County Health Director through or by way of the Harnett County
Division of Environmental Health if any of the following occur prior to well construction:
1.there is a relocation of the proposed facility;
2.there is a change in the intended use of the facility;
3.there is a need for installing the waste water system in an area other than indicated on the well permit;or
4.there are landscape changed that affect site drainage.
Contact information: Environmental Health Division- 910-893-7547
PROPERTY INFORMATION
Proposed use of well
Single-Family Multifamily) Church I Restaurant C Business P Irrigation 1
Street Address L.bt he ter (Lich 1241 Subdivision/Lot#
Parcel# O1iL CO Q21: PIN# hese • at — cc)°
Directions to the Site
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I have thoroughly read and completed this Application and certify that the Information provided herein Is true,complete and
correct to the best of my knowledge and is give in good faith. Representatives of the Harnett County Health Department and
state officials are granted right of entry to conduct necessary Inspections to determine compliance with applicable rules.
I understand that I am solely rerponsible Jos the proper idengficaiion and labeling yl all properly lines,undergrmmd agdry lines,and
making the vire accessible so tau a will ran he properh•emommed wow-ding w the peeing
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Property Owner's of Owner's Legal Representative Sign' e Req red Date
Jun. 19. 2017 1 :35PM No. 2561 P. 1
((}(l TOWN Or COATS ZONING PERMIT APPLICATION
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NOTE: Attach a she plan that lonludaa property Maes Wet,side,end rear),location of proposed eauotares(including driveways,
decks,eta.),and existing eaaceral. This plan should be drawn to scale. Also,la order to receive a Prtvllege License from the Town
of Coats to open a business,you must have a valid Zoning Permit,along with all applicable inspections from Harnett County.
Permit Rad 6619/7 / Date: (o"19-11 Feet a50.0d
Parcel ID": 011 (000 Da,(a Arca Zoned As: ('[ec, t1 r' .. (t A -
APPLICANT; PROPERTY OWNER:
Name(Print) S ijn0.funC_Swle- B•teiclers Name (overly I. S.4 -.
Addresslacq N, Minn S-I-. Address 6001 Kept. Rd
City,Stole Lill 1r34-••• NC City,State AtOre" N(-
Zip Code a'lSK(a Zlp Coda a a5O1
Phone# 410- 4$$-tt3('0 Phone CIin-Silk 42QQ
Location of Property: IN-TOWN ED r/ EV(contiguous)
Present Use of Property: A.,ya;4.t b✓-c
PRO a SED USE OF PROPERTY:
Single Family Dwelling: #Rooms: 8 #Bedrooms: dl-- Square Feet 2355
( ]Multi Family Dwelling: #afUnita: #Bodraons(per unit); Square Peet(per unit)
[ ]Mobile Home(single lot); Single wide: Double Wide;
[ ]Mobile Rome Park: Section 16,Zoning Ordinance must apply
[ 1 Business: Total of employees par day Type of business
[ 1 Others(specify):
[ ]Existing structure: Renovate: Addition; Demalleb:
WATER AND EVER SUPPLY:
Water: [witcYate [ l Public [ ]Proposed [ ]Existing 141Pi4
Sewer: , (41'r1vate [ ]Public [ Proposed [ ]Bxlating c hint
Applicant: I certify that oil of the Information presented in this application is true,complete,and accurate to the
best of my knowledge.� name information Is grounds far rejection of the application.
Gw
Signature: /k__--- Data: 4—m8"/
,,ZzOA7NOADMIMSTRATOjt USSOWLY
Notes: Wet f 7,4a /6r f& y... — Ta rp A n 5 >la littrex 1.7
l- eezth [oaf
,/9 Appravetl: [ ' Denied: ( ) l.. r/ //
Zoning Administrator: if; 7- �� Date; kW-/ /
, I
Post Office Box 675 • Coats,North Carolina 27121
(9101 897-5183 yoke • 19101897-2662 fax