DOCUMENTS Initial Application Date: W I ;t)' I 1 Application# I /. 1 .N.. --7 I r_sr
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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 RECORD D SURVEY MAP,RECORDED DEEDx�' (OR OFFER TO PURCHASE)6 SITE PLAN ARE REQUIRED
UUIIRRED WHEN SUBMITTING A LANND/USE
'AP/PLICATION*/'
LANDOWNER'. 1' CI� nL'1'ln. /yC-l'��,f6-{Y�ry Mailing Adddress':1_fl �1,,( �Sarig U ti l ( Ckd y LAB le
City / I'I(/1 t4i2 , n State:NCZip':'zt 1 J !QontactnNo': it l tOSc"LL/W (al:
APPLICANT':G./14 Le.au.„1St R f" :' 11�lzxl/ Mailing Address: t�� l �Gm uc.t /-'L Key _La n-e.
City: LIIII ti IDN Statej'JC Zip:'21c &Contact No'. Email:
'Please fill out applkept information it different than landowner
CONTACT NAME APPLYING IN OFFICE: Phone# Cy /�
PROPERTY LOCATION:Subdivision' - 1 E'T,x I �, , ) . -Lot#'. — Lot size':TRI 11as
State Road It `I---- Staatee Road Name: S c iy t._ ..M_A �/f,�l C'K..Fe�V LpaA'1Mdp Book&Page: �-k`
Parcel'. I anJ i C1 I al) (,0 J l �('� PIN: 6r1J1 `49 115- D 7 II 000
Zonin loud Zone: >0 Watershed.A lrl Deed Book 8 Pagel W7#01 I /DI Power Company:
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Maimlithiu
❑ SFD:(Size x )#Bedrooms #Baths: Basement(wlwo bath)._Garage Deck: Crawl Space:_Slab: Slab:
(Is the bonus room finished?( )yes ( )no wl a closet?(_)yes (_)no(if yes add in with#bedrooms)
U Mod:(Size x )#Bedrooms_#Baths_Basement(wlwo bath) Garage._Site Built Deck:_ On Frame Off Frame
B(////
� (Is the second floorfinished?
�(/_)yes (_)no Any other site built additions?(_)yes ( )y�n��`'�'�1{'��yy-��- ��+1�^ ,� p�
9
Manufactured Home._SW DW TW(Size /4 x 3V)#Bedrooms': ii Garage (site built?_)Deck'. _(site built?_) RD
❑ Duplex.(Size x )No.Buildings: No.Bedrooms Per Unitr�u'_iJr_�"
❑ Home Occupation:#Rooms: Use: Hours of Operation #Employees.
❑ Addition/Accessory/Other:(Size )Use: Closets in addition?(_)yes (_)no
Water Supply: aunty Existing Well New Well(#of dwellings using well L/ )`Must have operable water before final
Sewage Supply: (/ New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) County Sewer 11/
Does owner of this tract of land,own land that contains a manufactured home within five hundred feet(500)of tract listed above?(_)yes (Y)no
Does the properly contain any easements whether underground or overhead( )yes ( )no
Structures(existing or proposed):Single family dwellings: I Manufactured Homes: I Other(specify)'
LLUJ p°cc�CC(CL I/ ) J
Required ResidentialProperty Line Setbacks:tbComments./ . ! )ll
Front Minimum . _) Actual�l
2CD
Cr IC, 1�
Closest Side / `�
Sldestreet/corner lot 2C.
Nearest Building I
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
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SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: l wc21 to fST �D Sion y"/,,ee(/,�� Atacd (421
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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 s tements are ac urate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
2
Signature of Owner or Owner' gent Date
4
"9t is the ownerlapplicants responsibility to provldethe 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 Land Use Application Page 2 of 2 03/11
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
Witn lkaA itiC-Kay (p S'- 6 6 e e
Applicant/Owner Y Phope Number
f7(1 SQnia-1 A1tk'oy G-N Lrflirts• -lo el /VC o27S 14
Street Address,City, State,Zip Cdde 5
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 property 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 andior 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 100 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:
I.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 S Multifamily[ Church 7 Restaurant 7 Business 7 Irrigation
Street Address Subdivision/Lot#
Parcel# I i bS'}fit I ax Sal PIN# l7 S49 - y S - 7571 8-. (Yet
Directions to the Site
I have thoroughly read and completed this Application and certify that the Information provided herein iv 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 omeinis are granted right of entry to conduct necessary inspections to determine compliance with applicable rules.
I understand that lam solely responsible forrhe proper identification and labeling of all properly lines,underground utility linen and
making
nggtwthe
siteaccessible so threnat a will can he proper/,constructed according to the permit
< Owner's Legale �n .� �7
Pr try Owners of Represent Signature Required Date
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NAME:4i,,rd-in a417 A PPL I CA TI ON#:
'Thisapplicati o be filled out when applying for a septic system inspection.'
County Health Department Application for Improvement Per mit and/or Authorization to Construct
IF THE INFORMATION IN THIS APPLICATION IS FALSIFIED,CHANGED,OR THE SITE IS ALTERED,THEN THE IM PROVEM ENT
PE RM IT OR AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID, The permit is valid for ether 60 monthsor without ecpirstion
d�gidirg upon doptmerrtaion submitted. (Compldeste plat=60 months Compldepla=without erpiraion)
V/ 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 fags'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.
Ali 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 tank in a mobile home park)
I 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 authaizaion to construct please indicatedaarelsy dam type(s): can berated in or de of preference,mud dposaone.
{J Accepted {J Innovative ( y/Conventiond {J Any
(J Alternative (J Other
The applicant dell notify the local health depatmant upon submitted of Misapplication if arty of the following apply to the propely in
question. If the ansver is"yea',applicant MUST ATTACH SUPPORTING DOCUMENTATION:
(DYES {j NO Doesthe site contan any Jurisdictional Wetlands?
{DYES {]() NO Do you plaito have al irrigation sydern now or inthefuture?
(_1YES (Ai NO Door will thebtildng contain any drains?Reaseepldn.
(AJYES (' f} NO Are there any existing wdls, sings,waterlines or Westewaer Systems on this property?
(DYES {/_} NO Is ay wastewater gang to be generated on the Ste other that domestic savage?
{JYES { NO Is the site subject to approved by any other Public Agency?
{DYES {J NO Are there any Easements or Right of Ways on this property?
{DYES {i) NO Does the ate containaty existing water,cable,phone or underground electric lines?
If yes please call No Cuts a 800632-4949 to locate the lines. This is a free service
I Have Read This Appliraion And Certify That The Information Provides Herein Is True CompldeAnd Correa. Authorized County And
Rate Officials Are Granted Right Of Entry To Condud Nece;ary Inspetions7°0de(mineComplianceWith Applicable LaNS And Rule:
I Understand That I Am Sdely Responsible For The Roper Identification And Labeling Of All Property Lines And Corners And Making
�(TheSit A ble SaTh A Com IdeSreeEEvval ion Can BePeformed.
/p PRO RTP OR WNERSLE/ GM REPRESENTATIVE SIGNATURE(REQUIRED) ATE /
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Date; Application#
PROCEDURES AND GUIDELINES FOR MANUFACTURED HOME INSPECTIONS
RA-20R& RA-20M Certification Criteria
I, 711Jii— 2Cigd6rstand that because I'm located in a -20 r RA-20M
Zoning District and wish to place anufactured home in this district I must meet the following criteria,
verified by zoning Inspection approval,before I will be issued a certificate of occupancy for this home.
1. The home must have a pitched roof, for a manufactured home, whether A-shaped or rounded,
which has a minimum rise (measured at the center of the home) of twelve (12) inches for every
seven (7) feet of total width of the home. (Example: A home measuring fourteen (14 ft.) in
width must have a twenty four(24) inch rise as measured from the center of the roofline to the
baseline of the roof.) (See Illustrations Below.)
24'Minimum � ;F k' A-shaped . 24"Minimum r. t. I Rounded
Roof Pitch Rhe t•
4..,`—�. :�.. Roof Pitch Rhe .yr..
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Yds ,1 -1 i i ..,°;I} 3 a -1 ' 4 _ //�\_ - ._
Note: Most Rounded Roofs Will Not Meet The Roof Pitch —
Requirement As Illustrated. The Measurement From The Peak Of
The Roof To The Base Line Of The Roof Must Be 12" For Every 7'Of
Total Width Of The Home. (Ex: 14' Wide Home= 24" Roof Rise)
Continued
2. The home must be underpinned, consisting of a brick curtain wall or have galvanized metal
sheeting,ABS or PBC plastic color skirting with interlocking edges, installed around the
perimeter of the home. Skirting shall be consistent in appearance, in good condition,
continuous,permanent,and unpierced except for ventilation and access.
3. The homes moving apparatus must be removed,underpinned,or landscaped. (See examples
below.)
S i' �!$1 vS�.w) aha f
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'a ''�. C I /2003 Jt/602010.y.
4. The home must have been constructed after July 1" 1976.
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Signature of Property Owner/Agent Date
• By signing this form the owner/agent is stating that they have read and understand the
information on this form.