LAND USE Initial Application Date: z
/ - p Application # / P 5 0 2 C 74
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillingt NC 27546 Phone: (910) 893 -7525 Fax: (910) 893-2793 www.harnet ow/permits
LANDOWNER: fr/tial t €-t> 4 , Mailing Address: J 2 FP /5 e
City: n • �/ � �- / 1 State 1 GLip:_,v2$ j ontact # Emmaai
'APPLICANT*: a Mailing Address:
City: / State: Zip: Contact # Email:
*Please fill out applicant Information if different than landowner
CONTACT NAME APPLYING IN OFFICE: ye/� /
F Phone #
PROPERTY LOCATION: Subdivision: Z.- F .G .
I % /,// Lot #: L o t / Size; /
State Road* 6 777 7 State Road Name: AMC/ At& _ Map Book&Page: v l /
Parcel: /2
n QQ ✓ 7 /
;/ �J g? � PIN: �— �i S ) q^-- 5,7‘7, 006
Zoning: Flood Zone:_ Watershed: AO Deed BookBPage: /4 7/,l Power Company':
New 'structures with Progress Energy as service provider need to supply premise numbs from P ogress Energy.
• SPE IFIC D R TIONS T O PROPERTY FROM LILLINGTON: 4 ° '6i I i:. / i / I ./ i.
44 il‘ /
•
PROPOSED USE:
Monolithic
❑ SFD: (Size _x ) # Bedrooms:_ # Baths:_ Basement(w/wo bath):_ Garage: Deck:` j Crawl Space:_ Slab:_ Slab:_
(Is the bonus room finished? (_,J yes (ono w/ a closet? (-__) yes (ono (if yes add in with # bedrooms)
❑ Mod: (Size x ) # Bedrooms_ # 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
/Manufactured Home: r%SW _DW _TW r /
(Size_ /9 x {P] # Bedrooms: 3 Garage: (site built? ) Deck: (site built? )
uplex: (Size _x ) No. Buildings: No. Bedrooms Per Unit:
❑ Home Occupation: # Rooms: Use: Hours of Operation: #Employees:
❑ Addition/Accessory/Ot er: (Size _x___) Use: Closets in addition? (__) yes (ono
Water Supply: _ County .l Existing Well New Well (# of dwellings using well ) 'MUST have operable water before final
Sewage Supply: _ New Septic Tank (Complete Checkls( _ 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? L j yes (ono
Structures (existing or proposed): Single family dwellings: Manufactured Homes: Other (specify):
Required Residential Property
7
perty Line Setbacks: Comments:
Front Minimum 1! Actual I.
Rear 2 3- /7 Q
Closest Side /U J
Sldestreef/corner 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 fore 9 statements ar accu, ate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
Signature of Owner or Owner's Agent Date
"This application expires 6 months from the initial date if permits have not been issued"
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
Residential Land Use Application Page 1 of 1 07/10
SITE PLAN APPRCM* 7h / t
DISTRICT 5
Z USE
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NAME: APPLICATION #: IO 5 25
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) / 2 S "] V'
910- 893 -7525 option 1 CONFIRMATION# (
❑ Environmental Health New Septic SystemCode 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 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 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 putlid back In place. (Unless inspection is for a septic tank in a mobile home park)
• DO NOT EAVE LIDS OFPI* SEPTICJANK
• 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 system type(s): can be ranked in order of preference, must choose one.
{ Accepted. 1 —i Innovative 1 —) Conventional (_) 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 O NO Does the site contain any Jurisdictional Wetlands?
(_)YES O NO Do you plan to have an irrieation system now or in the future?
{_)YES {X) NO Does or will the building contain any drains? Please explain.
AYES ( NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
(_)YES 121 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 O NO Are there any Easements or Right of Ways on this property?
{_)YES O 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.
1 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 Perf d.
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PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATI SIGNATURE (REQUIRED) DATE
10 /10
PROCEDURES AND GUIDELINES FOR MANUFACTURED HOME INSPECTIONS
RA -20R & RA- 20M Certification Criteria
understand that because I'm located in a RA -20R or RA -20M Zoning
District and wish to place a manufactured 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 > q Shap as s' 24 Minimum �� Rounded,-
Roof Pltch Rise" J . ,, ,- ` 7■' Roo Pit
T-. . � n 4 - a ' Fr, '♦ is "' i
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x -. . . < t y S j ai'a I1 b>
7- xs y „, *fr f a a k
r ttoggo, C" Y 2 A 'A u jl 1 i'fr Y f a
v X 14' In Width �P # ( }
si !,f 14 I Wi l th f
4 4 1 ,3."2008 { r - ,�� � ��� ,F &, ;+ ,a 4 tk, ;;;;A■F
1 4 cioi, Note: Most Rounded Roofs Will
Not Meet The Roof Pitch
tor g Requirement As Illustrated. The
Measurement From The Peak Of
This Type Roof Design Will No Meet
The Roof To The Base Line Of
he Requirements Roof <Pitch . The Roof Must Be 12" For Every
'14,-1-1,71%MirriC In* a z - 7' Of Total Width Of The Home.
42, 414SIStt el f r t$04.44 ` (14' Wide Home = 24" Roof Rise)
Continued on back
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.)
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PAN L
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4. The home mustihave been` constructed after July 1 1976. r +'IS. '
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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.
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