LAND USE Initial Application Date: /Z _L/ -p Application # l ✓ ✓ Og 25
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.harnetl.org/permits
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LANDOWNER: /VC /< /r 4-7 '`t r "S1 Mailing Address: G7O Cris' ix ,ii::
City:/ / 7/, ic /c-L State/VC Zip;.?7Ytf Horne #: S!" , 9" 67 ✓, Contact #: if—L/7 61 C r
APPLICANT': A 0/1 z /I �a,.c ... r.a5.% Mailing Address: 67 D 6 Cr /
City: .ii / // State: /vC »YY m
Zip: Horne #: YF 65 "( 7 Contact #: Sdy 6 76 9
*Please fill out ap information if different than landowner
CONTACT NAME APPLYING IN OFFICE: ,4 /7G 1< ecl ,,.I „• r.191 Phone #: 7 f </' 6 76r
PROPERTY LOCATION: Subdivision: /91/.00 r-4' Lot #: ?I/ Lot Size: , ye° /,
State Road #:
/�C State Road Name: M9/ Z� C ' 5 ,(/ Map Book &Page:2'�'� (J / 527 7
Parcel: j 0/ -/✓ - 7� � , 9/A n J J PIN: 85 -7 7 1 / ' B � 41 - 99411.90g
Zoning: /) � Z Flood Zone: /y Watershed: �, �4 Deed Book &Page: Z frig / / 2 ZPower Company:
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: // et--/ , 7 . <A- e 7 , .2 /z`r y 1 r
7 <1 //74,- /I /7 .2 - Az r , / 7 v - y /vn- 6'a {c f 4 ' 7 c/r 4 ( .(/-
PROPOSED USE: (Include Bonus room as a bedroom if it has a closet) Circle:
/ 1. SFD (Size x yt ) # Bedrooms 3 # Baths v-12.- Basement (w /wo bath) P( GarageJ-r Deck /l /el (6 awl Space)Slab
❑ Mod (Size x ) # Bedrooms # Baths Basement (w /wo bath) Garage Site Built Deck ON Frame / OFF
❑ Manufactured Horne: SW DW TW (Size x ) # Bedrooms Garage (site built? ) Deck (site built? 1
❑ Duplex (Sizex ) No. Buildings No. Bedrooms/Unit
❑ Home Occupation # Rooms Use Hours of Operation: #Employees
❑ Addition/Accessory/Other (Size x ) Use Closets in addition( )yes Lino
Water Supply: (y Cou ( ) Well (No. dwellings ) MUST have operable water belore final
Sewage Supply: New Septic Tank (Complete New Tank Checklist) , . fisting Septic Tank ( ) County Sewer
Property owner of this Tract of land own land that contains a manufactured home w /in five hundred feet (500') of tract listed above? ( )YES (_)NO
Structures (existing or proposed): Single family dwellings Manufactured Homes . Other (specify)
Comments:
Required Residential Property Line Setbacks:
Front Minimum `' Actual i 6
Rear Z 7 /- P7e $
Closest Side // re
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Sidestreetfcomer lot / <
Nearest Building
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 submitted.
I hereby state that foregoing statements are accurate and correct 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 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: h «+'i t 7 Le , ,, , " ` 5 S 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 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 Tots 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 Existino 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 close back down.(Unless inspection is for a septic tank in a mobile home park)
• 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 s tem type(s): can be ranked in order of preference, must choose one.
1 -1 Accepted { Innovative { Conventional I_) Any
1 -1 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 (_g0 Does the site contain any Jurisdictional Wetlands?
(_)YES 1_1 NO Do you plan to have an irrigation system now or in the future?
{_)YES 1Li rv0 Does or will the building contain any glaille Please explain.
/
1_IYES 1 - NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
(_)YES {26J0 Is any wastewater going to be generated on the site other than domestic sewage?
{ _) YES 1_) NO Is the site subject to approval by any other Public Agency?
1_) YES 1 _) y .O Are there any easements or Right of Ways on this property?
{_IYES 1/1 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
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.
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PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
1 1/09
FOR RI1i61a TOR RE IS OF DEEPS
RNETT COUNTY TAX ID# 1 NOV 1 11 :26: AM
tiv • I 4a • BK,2008 P6:422.426 FEE: 25.00
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m, w . 0 / '� . I NC REV 5ii4'P:�
WS W a et.. s • N 12116721
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e I 4 AROLINA GENERAL WARRANTY DEED
Excise Tax: S 250.✓' i
Petrel Identifier No. a, Verified by County on the _ day of , 20_
By:
Mail/Box to: TIop C ie, " ' N. McPherson Church Road, Ste B, Fayetteville, NC 28303
This instrument was prepared by: v ia1 ::. -.:+-d le & • • P 150 N. McPherson Church Road, Ste B. Fayetteville,
. i —
Brief w
f description for the Index: • —
THIS DEED made this 16th day , ONuv - b,. , 2010 by and between
GRANTOR GRANTEE
Regency Homes, Inc.
6506 Dental Lane Cummings, LLC
Fayetteville, NC 28314 630 ' Road
//�/1 th , NC 27346
Enter in appropriate block for each Grantor and Grantee: name, . ague, ° , • if appropriate, character of entity, e.g.
corporation or partnership.
The designation Grantor and Grantee as used herein shall include : ( -. , successors, and assigns, and shall include
singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, fora valuable consideration paid by the , - • -: 11 " is hereby aclmowledged, bus and
by these presents does grant, bargain, sell and convey unto the Grantee in fee n n lot or parcel of lend situated in the
City of Township, County, North Carolina
and more particularly described as follows:
See Attached
The property hereinabove described was acquired by Grantor by instrument recorded in Book ri
3 : •i 0 .
All or a pomdon of die property herein conveyed _ includes or X_ does not include the primary resi ■ , ,,
A map showing the above described property is recorded la Plat Book 2008 page 504 .
NC gar Anacf Wan Form Na 3 o I976. Revised 0 111/2010
Printed by Agreement with the NC Hat Amchitka