LAND USE R Initial Application Date. S7 -• , • 1 ��� I I l I
Application#
CU#
tOUNTY6F-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.harnett org/permits
"A RECORDED
"SURVEY`MAAP,RECORDEDCO�rDEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTINNG7A LAND USEAPPLICATION^
LANDOWNNEE�R_ ` .I� Mailing Address- - 7-- %'«XE /Trn/ wazy
City: �+-A-al.,µ.4- �� ///����Sttaatre: /Ziipo4�j Contact3,-Arg
NNoo:9'9//770 --'44/Ser�`.E.m/ail:AtentZ'tir/7/tetlinli. en
APPLICANT':9/A AltlYk aile�/C,,rUs /�lF�,�yu�AMg fling Address: 7^7-Z �I�9E kz601ov 1'�r ' �7 fs """��, A,,r
City: \ 1S Stateaj Zip: �jj ntact No:%/ „9z /175 Email: / tlieSi x704 i it
'Please fin out applicant information it different tan landowner P C/ //rJ �/
CONTACT NAME APPLYING IN OFFICE �7 // /�q��/7nue Phone# �1/ v°-"�"777/
PROPERTY LOCATION:Subdivision':�r SteS !//-'93d _ Lot*: � Lot Size: N•ea-1
State Road# State floAdName'. —tient t -d /AO
and
/ /]��� '/ Map Book&Page:e�t37� /
Parcel: /..rQpnd -00. / PIN: 'NOii/Ja�-�47''/Y3�"O;d lD
Zoning 'JO Flood Zone: Watershed': Deed Book B Page: / ro /J±Ipower Company'.
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
E SFO. (Size x )#Bedrooms:_*Baths: Basement(wlwo bath): Garage: Deck: Crawl Space: Slab:_Slab:
(Is the bonus room finished?( )yes ( )no w/a closet?( )Yes ( )no Of yes add in with#bedrooms)
E Mod:(Size_x )#Bedrooms_it Baths Basement(w/wo bath) Garage:_Site Built Deck_ On Frame_Off Frame
(Is the second floor finished?( )yes (._)no Any other site built additions?( )yes (_)no
E Manufactured 1-lonie._SW __DW TW(Size x )#Bedrooms Garage: (site built?_)Deck: (site built? )
E Duplex_(Size x )No.Buildings- No.Bedrooms Per Unit:
Home Occupation#Rooms Use: Hours of Operation: ((o� ��++ #Employees.
�l! f 7-rO ` � (,.rig- �CYtLL
ul! AtltlitionlAmessorylOther(Size satZ xJ Us .4' Closets in addition?xs-e-, )yes ( )no
Water Supply County Existing Well New Well(itof dwellings using well )'Must have operable water before final
Sewage Supply: New Septic Tank(Complete Checklist) T' 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 ( v,no
Does the property contain any easements whether underground or overhead( )yes (Zno
Structures(existing or proposed) Single family dwellings: ManufacturedtuHomes: I I ' Othert (specify):�
Required Residential Property` line Setbacks: Comments: Cr 1,' I (6 icy-to i Rn (� filo 'r 10
Front Minimum >JJI Actual T �n iif • & I • v-4 rYiNt r
Rear )461 1(1
-[c{ S r
Closest Side
> //' G93" ` 'lb '--Z-e--
SidestreeVCOrner lot
Nearest Building
on same lot
Res:donee _a..., use Applicator Page 1 of 2 03111
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECT NS TO THE PROPERTY FROM LILLINGTONN. le� 111/26"/ O/V. YZ9'3 S(.
eid AA
Dara fsaels �' 7.'& M5 f1%`ide ,W72 Ti Peirle Ra
�timminai` CAl Lo r
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 dccorrect two the-b best of my knowledge. Permit subjectbjto revocation if false information is provided.
SignatureOwner or Owner's�� Agent J ata
"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 applications.***
"This application expires 6 months from the initial date if permits have not been issued"
4 s .. ... ppu:•,.00n •'ege;2 si :: 031' I
NAME: APPLICATION k: Lfl r2)O
*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) • S• •
910-893-7525 option I CONFIRMATION#
Environmental Health New Septic Svstemeode 800 1I,,
• All property irons must be made visible. Place "pink property flags' on each corner iron of lot. All'pr ape y
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 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 Exlstino 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 8 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.
• k•e Click2Gov or IVR to hear results. Once appro -d, proceed to Central Permitting for remaining permits.
SEPTIC
If applying for thonzation to construct please indicate dcsir• system type's): can be ranked in order of preference.must choose one.
(—I Accepted { I Innovative I I Conventional ( I Any
( I Alternative (—I Other
The applicant shall notify th. ocal health depa cut upon submittal of this application if any of the following apply to the property in
question. If the answer is"yes , •plicant M .T ATTACH SUPPORTING DOCUMENTATION:
( )YES II NO Does the sit- `ntain any Jurisdictional Wetlands'!
{_IYES { } NO Do you pla, to h. an ifrieatou system now or in the future?
(_IYES II NO Does or ill the build' contain any'rads?Please explain.
I—IYES II NO Are tl -re any existing well.,springs,waterlines or Wastewater Systems on this property?
{_IYES I } NO Is • y wastewater going to he ge rated on the site other than domestic sewage?
I—IYES II NO the site subject to approval by any c er Public Agency?
( IYES { I NO Are there any Easements or Right of Ways this property?
{_IYES II NO Does the site contain any existing water,cable, ••me or underground electric lines?
If yes please call No Cuts at 800-632-4949 to locate he lines. This is a free service.
I Have Read This pplication 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 Untie land Thal I Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The ite Accessible So That A Complete Site Evaluation Can Be Performed.
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PEATY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) D TE
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