DOCUMENTS Initial Application Date: / 1 -^I`��/._.l^�/A�`I `�I, l] U S'
7/Z t Application# L ( l
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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.harnetl.org/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)8 SITE PLAN ARE REQUIREDWHEN
SUBMITTING A'L`AND USE APPLICATION'
LANDOWNER: If MGC) fr!OIG.0 /5 Mailing Address'. ICI a,14 `41/4- ) 'II 1 recQ c:4 :2l)3
City: 12 w1 \<. 11, StateWCZip: 2'14enContactNo: (9i4) 935"11 ma9. \ANwC#.s411:l
a � , wL � 2wt,'I
APPLICANT': L,yMn Lt 14-1,H'e6 �� Mailing Address.
City: State. Zip: Contact No. Email:
'Please fill out applicant information if different thanlandowner
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CONTACT NAME APPLYING IN OFFICET IbVit—)Gree
Phone 4 q ii ) 13 f- 91$z
PROPERTY LOCATION:Subdivision: \ h�2y ‘31.19°
�G e1e�. n p 1— Lot#. q Lot Size: •• 2I �/
State Road it /I ry State Road Name'¶3. 0c T� v'1 e w (�nCOL A Map Book 8 Pag yTTl 17 13
Parcel'Oil
04.07� I/" -° / /C> a(� PINeD 2i ; ��o
Zoning:RA30 Flood Zone: X Watershed. 11:4 Deed Book 8 Page'. &$i) fl I S Power Company 1)ciKe ver,
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
/ / Monolithic
SFD (Size x ��#Bedrooms'.3 #Baths:2Basemen[(w/coo bath)._Garage:✓ Deck:✓/Crawl Spac$�Slab Slab:
(Is the bonus room finished?( )yes (_)no wl a closet?( )yes ( )no(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:_SW_Dw TW(Size )#Bedrooms:_Garage: (site built? )Deck: (eke 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: ✓ County Existing Well New Well(#of dwellings using well )'Must have operable water before final
Sewage Supply: ✓Naw 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 live hundred feet(500')of tract listed above?( )yes no
Does the property contain any easements whether underground or overhead(_)yes (-1 tyro
Structures(existlng or proposed):Single family dwellings: I Manufactured Homes'. Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum 35 Actual 517
Rear
Closest Side to 32-
x
SidestmeUwrner lot
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: 17q K t / ' p t° 444-5,./
DI
I UrN C/5,A < 104-y .5 5 6 7 rrr f,a f 4-urn 2 In f O in
old t er Crce6 2d 10 3 M r'!os ole ow 612,,nt off y1171—
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 correct to the best of my knowledge. Permit subject to revocation if false information is provided.
7/z///?
i lure of Owner or Owner's Agent Date
• '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"
•
Residential Land Use Application Page 2 of 2 03/11
.t
LEGEND
CI - CENTERLINE NOTE'.
ECM - EXISTING CONCRETE MONUMENT
9G CAL BY COMPUTER
P - EXISTING A
TING IRON PIPE AC. PU OM
FRd5 — EXISTED RAILROAD SPIKE
ESI - EXISTING SOLID IRON SEWER. .PUBLIC
SIS - SOLID IRON SET MIN- BUILDING SErBOCK LINES
ERRS - SET RAILROAD SPIKE 35' FRONT
r.D. TOTAL DISTANCE KENNETH RAY THOMAS, JR. 25' REAR
PB - POWER BOX DU BOO, P. 245 10 SUE
ESI
579.29.15.E
23183'
_
ES
FP �Eo ® 25 SF78ACK
0.61 ACRES
'' CALCULATED BY COMPUTER
� HE CREEK'
W C F SLUE ]57-R
" THE CREEK' Mp/ 4
It
FC F, AIDE 777-B S \ N �A
9
3
iTe� ep 'a n. 'T.
llI;
iRi�- SCiB > !b� "RIE@EEK" I'8^
T p li 4CT 0K PC P, SLIDE 777-B
\ Inll E
ESI
17/Wyo
Sews,CH
31 51 oWG R w GRAPHIC SCALE
R = 611 ' \ aRE,9 9
L - 59'
( IN FEET I
BROOKVIEW COURT1 men - 40 ft
PAVED Rom 5D'R/W
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OWNER
NOTE LAM.= CUSTOM REFERENCE
5 IS A PHYSICAL SURVEY ONLY BbILDERsLE LAMDO _,90M
,
DOES NOT MEM GS47 30 NOT FOR RECTERDATION. }00 NOWELL ROAD BU'.l➢EHS, ELS
RALSGH, NC 27607 DB 3471, P. ]BO
NOTE. PEWS Oat AODEESTHE CREEK SUBDIVISION
THIS SURVEY IS OF AN EXISTING PARCEL OR PARCELS. BB EROOKNEW COURT PC F SLIDE ]]7-8
NOTE ANGIIER NC 27501 LOT 4
THIS PROPERTY IS SUBJECT TO ANY AND ALL EASEMENTS.
RIGHT OF WAYS. AND AGREEMENTS OF RECORD PRIOR TO IDIS PLAT.
Ihon=GS 1 AIO,Ihe {] b6
certify ton- th S a Eth
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q AT AT TAT
Yo anactual s 4r,‘Lu'n ft LAMCO CUSTOM STAX TAT
mysupervision. ' 1 xi* ed r e BUILDERS, LLC. — E
Plat prepared c c rawFgess N1 Go (MIAOW 137-10-2017
i THE CREEK_LOT 4 MAN
standards of ' P sa`t'e. for LalaO --
surveying in Norty A Ni &R 3 Tnouw,s T. MATnErs RATTANSwe T
q 0 PROFESSIONAL LAND SURVEYOR Imus
V4'S J. MP 22e s. TRADE STREET =ARCA '- 37e5A
�.�� . suite z _
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v' �ii / l0.,-19-2017 SANFORD, N . 21922 r707
Thomas J. Matthews Date tlnew.e.ry
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NAME:Lwrnco Nv-nesAPPLICATION#: _
*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 TIIE 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 S{
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 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 Drool 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)
• 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.
• 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.
l Accepted I—} Innovative I Conventional { 1 Any
Alternative 1—} 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—I YES { } NO Does the site contain any Jurisdictional Wetlands?
—{YES IY{ NO Do you plan to have an irriggtionsystem now or in the future?
f—1 YES I—} NO Does or will the building contain any drains?Please explain.
YES 17Xl NO Are there any existing wells.springs, waterlines or Wastewater Systems on this property?
(YES 1$1 NO Is any wastewater going to be generated on the site other than domestic sewage?
}YES ( l NO Is the site subject to approval by any other Public Aeency?
II YES IYl NO Are there any Easements or Right of Ways on this property?
YES 0C-1 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
Slate 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 Accessible So That A Complete Site Evaluation Can Be Performed. �/�/ f/
=C C
PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
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