DOCUMENTS Initial Application Dale: rip-411") Application# i SOO q I 0
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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.harnelLorg/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WREN SUBMITTING A LAND USE APPLICATION"
LANDOWNER:Wynn Construction, Inc. Mailing Address:2550 Capitol Dr.Ste 105
City: Creedmoor State:NC Zip:27522 Contact No: 919 603-7965 Email: edward@wynnconstruct.com
APPLICANTS Edward Averett Mailing Address:2550 Capitol Dr.Ste 105
City: Creedmoor State:NC Zip:27522 Contact No: 919 603-7965 Email: edward@wynnconstruct.com
`Please fill out applicant information it different than landowner
CONTACT NAME APPLYING IN OFFICE: Edward Averett Phone#919603-7799665 �J
PROPERTY LOCATION'Subdivision: Avery Pond ������ D 1 (� Lot#:_1 / 'Lot Size: • /
Stale Road# 3 (p (42 Slate Road Name::_ / 44/0 en-i 101.(C V7�• qz�p��jjMap Book&Page: �G /2o✓
Parcel: os OSO6S3 002? 63 . (PIN: O&,S3- Ze ', //O(a -
Zoning: FI`30 Flood Zone: ?Ci. Watershed:/v/ 1 Deed Book&Page:3 IO/70 L( Power Company': Duke Energy
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
/� CLIP / Mon,aai.p
vs SED:(Size (Oil x 420)#Bedrooms:7�/ #Baths:2 Basemenir^rpo bath): Garage: ✓ Beak:✓ Crawl Space._ _Slab:_Slab
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gs the bonus room finished?(.41-yes _,no w/a closet?( 1 yes ( )no(Ryes 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 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/Accessary/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: ✓ New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) _County Sewer
Does owner f this tract of land,own land that contains a manufactured home within five hundred feel(5003 of tract listed above?(_)yes 1 )no
Does the properly contain any easements whether underground or overhead(_)yes ( )no
Structures(existing i r propose):Single family dwellings: t Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
j/
Front Minimum 35 Actual_J6_
Rear 25 SO
'
10 (S,8 7
Closest Side
Sldestreeticorner lot 20
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: From HCCP right onto 210 Hwy.3 miles, Left on 401 Hwy.for 15 miles
Left on Chalybeate Rd,for 143 mile,Avery Pond on the left
If permits are granted I agree • enter to ordinanc nd laws of the St a Orth Carolina regulating such work and the specifications of plans submitted.
I hereby slate that forego) : tame accurate erre to the be knowledge. Permit sublecltto r v cation if false Information is provided.
IVtura of Owner wear's Agent Dattee
mit 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
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SIT t PLAN APPROVAL
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NAME:�M Loa6fiveriew l fc - APPLICATION#: _
/ *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 per mit 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 I CONFIRMATION#
Environmental Health New Septic System Code 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.
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(s): can be ranked in order of preference,mast choose one.
{_) Accepted {_} Innovative {/onventional { ) Any
1_} Alternative {_) Other
The applicant shall notify the local health department upon submittal of this application if any of the following apply to the property hi
question. If the answer is"yes", applicant MUST ATTACH SUPPORTING DOCUMENTATION:
( )YES (LNO Does the site contain any Jurisdictional Wetlands?
{ )YES {4-NO Do you plan to have an priaation system now or in the future?
(_}YES { if 1 Does or will the building contain any Sha. ?Please explain.
{_)YES ( )NN)_ Are there any existing wells,springs, waterlines or Wastewater Systems on this property?
{_}YES (L} NO Is any wastewater going to be generated on the site other than domestic sewage?
{_}YES (4-/NO Is the site subject to approval by any other Public Agency?
(_)YES {4/NO Are there any Easements or Right of Ways on this property?
( }YES (Z 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.
I Underst' h' I m Solely Rasp sible For The P'.- . tification And Lnbeling Of All Property Lines And Corners And Making
The •ss So at A Co etc;it veinal',/,' • - " ormed. _//7
• • r . RTY ERS OR OW�•S LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
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10/10
DO NOT RLMOVEI
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