DOCUMENTS Initial Application Date: 1)i'4 )1 Application# 11 .JO`s "'T I Q "1 11
CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Cental Permitting 108 E.Front Street.Lillington,NC 27546 Phone:(910)893-7525 exl:2 Fax.(910)893-2793 www.harnett orglpermits
'•A RECORDED SURVEY
MA CORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE
/REQUIRED
/WHEN
N SUBMITTING/ A LAND USE APPLICATION"
LANDOWNER:/ / /trMr-x( '1 `?tICoo/v ^/ Mailing Add�rress:: q` al `i $']T go"Li fC cd
City: LI IO Mtn fJ/ l �y�State'.1LZip-1 +4 Contact No: (q)43) ?Tv -2/ mail. 44-ss CJt�-A4
APPLICANT': r • 'Y% 4 t 3"41 " Mailing Address. ?U ""/5p77
City: 1JGGY/141-rN State:/I'Z- Zipn7rib Contact No.6 lt3 81#-7103 Email:
'Please fill out applicant mmmavon i
if diferent than landowner( (�)
CONTACT NAME APPLYING IN OFFICE:./ M PUSS r� Phone# (2 !Ol C 7o `2/p3
PROPERTY LOCATION:Subdivision. JQ.MAG!.S L. FG Dom\ Lot#: — LotLoSize:S • CL1
State Road# /Z� /State Road Name:Oe `Y'_,z•Cw41 /: a Map Book 8 Page I / a3
Parcel:��//��k7 osa. DO O o . _ PIN'. vs a'I - 4 £ - is t- • eco
Zoning`ZPara Flood Zone: (C Watershed( • Deed Book 8 Page: CH I I S e(49Pawer Company
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: 1 3 2 / n' •
��// ✓ xI /Slab: thlc
SO SFD'.(Sizes x 6T )#Betlrooms. #Baths: Basemen[(wlwe bath)'. Garage: Deck: Crawl Space:_Slab.✓ Slab:
(Is the bonus room finished?(_)yes ( )no w/a closet?(_)yes (_)no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms_#Baths_Basement(wlwo bath)_Garage:_Site Built Deck:_ On Frame_Of Frame_
(Is the second floor finished?( )yes ( )no Any other site built additions?( )yes ( )no
❑ Manufactured Home:_SW_DW TW(Size x )#Bedrooms:_Garage:_(site built? )Deck:_(site built?_)
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms. Use: Hours of Operation: #Employees:_
❑
Addition/Accessory/Other:(Size x )Use: Closets in addition?(_)yes ( )no
Water Supply: `x County Existing Well 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 fivehyred feet(500')of tract listed above?( )yes ( )no
Does the property contain any easements whether underground or overhead(_)yes (_)no
Structures(existing o poseg1 Single family dwellings: ` p0�Manufactured Homes: Other(specify):
Erna
Required Residential Property Line Setbacks: Comments: C3
Front Minimum 3 5 Actual �3-5-.?
Rear -I Z'
Closest Side I h /02-
Sidestreetkorner lot
Nearest Building
on samelot
Residential Land Use Application Page1 2 03/11
APPLICATION CONTINUES ON BACK
•
SPEC)/FjJC DIRECTIONS TOKTHE! PROPERTY FROM LILLINGTON:--�� f r lC l�,yzr L-fq-L� � �/ 5�7 f t A T�',�
(LT 9N ` Y 6-rsw 4-7 Sib (.4i ApP401 /if ✓11/LE bN 1.-EP-1
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 slat +r accurate and correct to the best of my knowledge. Permit subject revo tion if false information is provided.
Signature of Owner or Owner's Agent ate
"'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 overheats easements,etc.The county or its employees ere 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
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NAME: A\r255 ( 1"htLfe"141"-ACLS- APPLICATION ft:
*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 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 verity results. Once approved, proceed to Central Permitting for permits.
0,/ 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)
• 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 type(sh can be ranked in order of preference.must choose one.
II Accepted { Innovative I Conventional LI Any
I Alternative { I Other
T. applicant s I notify the local health department up . ..•.ittal of this application if any of the fo owing appl- o the property in
uestiun. If the arts ter is "yes",applicant MUST AT. ACH SU' 'ORTING DOCUMENTATION
1—I YES I_I NO Does the site contain a Jurisdictional -Hands!
I—1 YES I_I NO Do you plan to haveirrigation l:wem n w or in the future?
I—!YES I—I NO Does or will the h ' ding contain any t l '!Please explain
LIVESI NO rc there any ex' ting wells,springs. wale ines or Wastewater Sy ems on this property?
I—I YES {_I NO : any waste ter going to be generated on the site other than do estic sewage?
l YES I—i NO b the site ubject to approval by any other 'uhlic Agency?
{ I VES { I NO Art t re any Easements or Right of Ways m this property?
I_IYES 1_1 NO Does the site contain any existing water,ca.le,phone or derground electric lines?
If yes please call No Cuts at 800-632-4949 I. locate - lines. This is a free service.
I Have Read This Application And Certify That The Information Provided He e n Is True,Complete And Correct. Authorized County And
Stale 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 Ace sible So That A Complete Site Evaluation Can Be Performed.
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PROPE Y OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10