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LAND USE RR Initial Appicatl4n Date: -7-DID-1 r Application eel GI o/D 395 I DF)' ` Cu# COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION �1�� • Central Permitting 108 E Front Street,Lillington,NC 27546 Phone.(910)893-7525 ext:2 Fax:(910)893-2793 .hametf Vry sy• t,•, "A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SHE PLAN ARERyRRE/QQUIIRxED WHEN SUBMITTING A LAND DUUSE .EIA TION" LANDOWNER:5�C. taterc Mailing Address: 1xeW lJiM c— 1�-l. SIC a 1 ♦ : 7^�9��1I City: 1 l� State: p�(rY booted No: Email: APPLICANT*: ��//T1 GM �l ,Sl f. Mailing Address: 25S CYPXYI.reS C� City: '$111&,)1 QC State:1`tl Zip ontactNo9lq U2.1-71IN Email: t adOWe$€i/1(•4'y1G*i I.Com 'Please fill out applicant information if different than landowner Davits / ,, �J�1[y /z/� ��-y/ CONTACT NAME APPLYING IN OFFICE: .\�x��l,,r iadPhone# q(9I- u 2. /7 0 pW PROPERTY LOCATION:Subdivision:QQII !T`✓S \ vtf k Imo, /1 app r/ ^ Lot#: U/ Lot �Size. 10 aneta State Road#I I /. �1 State ��Road Name: Po Yn+V .S \ A L - KJ r. Map Bock&Page:eQOt0/ 1q7 Parcel: O LI 0(1)4 ;. Sr-14 OS PIN: °1Can.-�t11I - I ' ` , r �e1 Zoning Flood Zone: `n/ Watershed: Deed Book&Pagepl7IQ IOU' FS Power Company". 'News uc ure with Progress Energy as service provider need to supply premise number from Progress Energy. ilk • USE: 4‘ l SFO. Size #Bedrooms: #Baths:_Basement w/wo bathX. Monolithic ' ` ( 1 -� ( bath). Deck Crawl Spa Slatr. o (Is the bonus room finished?(.)yes ( )no wl a closet?(_)yes (. )no(if yes add in with#bedrooms) U Mod (Size x )#Bedrooms it Baths_Basement(wlwo bath) Garage: Site Built Deck:_ On Frame OH Frame_ (Is the second floor finished?(_)yes ( )no Any other site built additions?(_)yes (_)no ❑ Manufactured Home:_SW_DW_TW(Size -x )e Bedrooms._Garage: (site built+_)Deck: (site built?_) ❑ Duplex:(Sizex )No.Buildings: No.Bedrooms Per Unit. U Home Occupation:#Rooms: Use: Hours of Operation: #Employees: ❑ Addition/Accessory/Other:(Size x )Use: Closets in addition?(_)yes ( )no Water Supply: / County Existing Well Y. New Well(#of dwellings using well )'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 O yes ( )no Structures(existing or proposed): Single family dwellings: Manu tur d Ho es ^ Other(specify): Required Residential re erb,time Setbacksr:\ i i Comments: _ _1l1�� / Front Minimum , �f Actual ROO ` V5 t (..L�Le7LS) nQ - i e Rear 2-54.-- acLe%0 ct3. Closest Side I tt 1 CS (1-51 ‘..\11..g5 SidestreeVcorner lot r) \Y•. 41%-C Nearest Building s7 a 1/+t I It A - on same lot Residential Land Use Applieallon Page 1 01•--fes-`L APPLICATION CONTINUES ON BACK . J` tffLc SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: 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 ccurnd correct to the best of my y knowledge. Permit subject to revocation if false information is provided. 'filkia or '�jic)Ra Signature o Owner or nets Agent to "'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 Land Use Application Page 2 of 2 03/11 NAME: O11Q1d ✓QvJeS APPLICATIONS: ✓ I ✓( o .11 *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) 0 1 / ) r� 7_ I-1V) 910-893-7525 option I CONFIRMATION# Col (7� Environmental Health New Septic System Code 800 I � All property Irons must be made visible. Place "pink property flags" on each corner iron of lot. All propSrty 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. r Environmental Health Existin°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 & 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 typc(s): can he ranked in order of preference,must choose one. ( I Accepted 1J Innovative II Conventional I—I Any (_) Alternative { I 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: I—}YES {�,NO Does the site contain any Jurisdictional Wetlands? I }YES II NO Do you plan to have an jIIll3tlen syste n now or in the future? If f_ I—I NO Does or will the building contain any drains?Please explain. Clw+ er ‘Sic Ai NY { IYES li.}NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property? (IYES f_ NO Is any wastewater going to be generated on the site other than domestic sewage? 1IYES I ✓ 410 Is the site subject to approval by any other Public Agency? I _IYES I �I NO Are there any Easements or Right of Ways on this property? 1 }YES II 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 Thal 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 Properly Lines And Corners And Making The Site ,cc• ib .•Th 'omplete( e Evaluation Can Be Performed. iiic i 4 'lir .' Z5 PROP RTY OWNERS OR OWN 'S LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DAT 10/10 HTE#fg.- - 39310 R. Permit # Z1 / 7a Harnett (bung- Department of Public Health Site Sketch !J PROPERTY LOCATOR. 5-CISSUED TO: 1Y1,,,_ „... ,Dl�``CA !{,�/�SUUBBDIVISION C.L%a¢x.-k ' LOT # Co rc Authorized State c E!p i l .,) te: L -ZZ-/Z �. no —/....., <rd ev �____----- ,r__, i ,� v ti a � Rr / ' NI P - \_1., \ �pY \ 11.7 Z t , Fnufr TA \ pafit43 lwL. At Lo+ lt- G, 3c01'p; r\ttrS CceeK ---7\ - — I lar u I N ill I SITE PI AN ALII p OVAL DISTRICT [_A- 6___i13E- - g6EUP04-1 01; a li.ti ratreb Ln r r