DOCUMENTS Initial Ape/Ration Date. 41---- 11 / Application 1 riJV I )9 , S ?J
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION C
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Central Permitting 108 E.Front Street,Llllington,NC 27548 Phone:(910)893-7525 ext2 Fax:(910)883.2793 www.bemelt.org/permile
"A RECORDED SURVEY'' MAP,RECORDED DEED(OR OFFER TO PURCHASE),SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
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LANDOWNER: ,e Ar T0A41D( Mailing Address.
city isithiLzlp iocontactNo:RIO-c.c+Lca0Ernau: 2by84..3#4"57et lam,
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APPLICANT': ism-talch-1—a jO( Mailing Address: Sa.w.��
City: � / Slate: Zip: Contact No:
*Peaks M out applicantWametlon if different thanTlandowner' t Em,ll:
CONTACT NAME APPLYING IN OFFICE: Mn.rYMnP T r Phone it ?Ib- \�x _( sQa
PROPERTY LOCATION:Subdivision: 4$k" . 72,)(J'D-( \ Lot I: JO Lot Size:: I 'da 0
State Road M Slate Road Name: U S Y�7 /V Map Book 8 Page..;0)r7 p4
Parcel: 13 DV?J 0- 5 a i PIN: 010 36--. 36 -79! `f.
ZoningNaha Flood Zone: X Watershed: Deed Book 8 Page:391g / 218 Power Company:
'New structures with Progress Energy as service provider need to supply premise number
from Progress Energy.
PROPOSED USE: Si CC c. .pa��.(,^
El SED:(Sizes x d),Bedrooms.5J f Baths:'Bp ement(w/wo bath): 'Garay 1� Deck:rCravA Space:_y_Slab:_Slab:Monolithic
(Is the bonus room finished?(d[,)yes LJ no W/a closet?(4,4yes ( )no(N yes add in with I bedrooms)
U Mod:(Size_x_),Bedrooms a Baths_Basement(w/wo bath)_Garage:_Site Built Deck:_ On Frame_Off Frame_
(la the second float finished?(J yes LU no My other site built additions?(J yes (J no
❑ Manufactured Home: SW_DW TW(Size x )a Bedrooms: Garage:_(alto built?_)Deck: (site built?_)
❑ Duplex:(Size_x_)No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:I Rooms: Use: Hours of Operation: ,Employees:
❑ Addition/Accessory/Otter(Size_x )Um:
Closets In addition?L.)yes (_)no
Water Supply: J County _Existing Well _New Well(Rot dwellings using well )'Must have operable water before final
Sewage Supply: 1/ew Septic Tank(Complete Checklist) _Existing Septic Tank(Complete Checklist) _County Sewer
Does owner of thio 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(_)yes L)no
Structures(existing reposedngle family dwellings: Manufactured Homes: Other(epedly):
Required Residential Property Line S&M ocks: Comments:
Front Minimum_ Actual S--11 .a-
Roar
Ckweel Side _ �—
Sidestreet/corrwr lot /y 6' D
Nearest Building c.---------__'
on same lot
Residential Land Use Application Page I ol 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONSITO THE PROPERTY FROM LILLINOTON: z�f, (J G C4—. 11 I v *oc.a id S
Sa„�prrjt, 17pn r'Pr+1 n+` l '4± r, (-)1A.-1- bu.�nr e- N...‘,11 -n.e.aS
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 stale that forego! tabments are accurate and correct to the best of my knowledge. Permit subject to revocation if false Infonnadon is provided.
Signature oNDxD r or Owner's Agent pate '
Y'll Is gu owner/applicants naponsjbllky ata 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 resyoselbie for any
incorrect or missing Mfonnagon that is contained within these applications!"
"This application expires 6 months from the initial dab H permits have not On Issued"
Residential Land Use Application Page 2 of 2 03/11
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NAME:
APPLICATION x:
"This application to be tilled 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 I CONFIRMATION a
0 Fnvlronnrental Health New SODS SvstsmCode 800
• All property Irons must bo 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.
• II property Is thickly wooded, Environmental Health requires that you clean out the undararowth 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!nominee(
for failure to uncover outlet lid, maga house corners and Imogene lines.etc. once lot conflmed ready
• Alter 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 oroof of request.
• Use Cllck2Gov or IVR to verify results. Once approved,proceed to Central Permitting for permits.
0 tflvlfonmental Health Existing Tank inspection• 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 Ild back In place. (Unless Inspection is for a septic tank In a mobile home park)
• DO NOT LEAVE UDS 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 Drool of recuest.
• Use Click2Gov or IVR to hear results.Once approved, proceed to Central Permitting for remaining permits.
SEPTIC
H applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference,must choose one.
1_I Accepted 1_)Innovative 1U1 Conventional 1_1 Any
(-1 Alternative 1-1 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:
f_}YES LsA NO Does the site contain any Jurisdictional Wetlands?
1—)YES I j)NO Do you plan to have an udeation system now or in the future?
1—}YES l NO Does or will the building contain any afajap?Please explain.
IIVES Lsii NO Are there any existing wells,springs, waterlines or Wastewater Systems on this property?
1_IYES (y' NO Is any wastewater going to be generated on the site other than domestic sewage?
1_1YES Lie NO Is the site subject to approval by any other Public Agency?
1/1YES (_1 NO Are there any Easements or Right of Ways on this property?
1_IYES 1�"r!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 Rales.
I Understand Thal!Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
le So That A Complete She Evaluation Can Be Performed.
P RTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) ZDATS'/1,r
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Do hereby oorMe perm ee of PIM mr the p,rept',) form(e)or apomto sl Wrfomwro .workl
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HARMETT COUNTY CASH RECEIPTS
OPer: JB ROCK CUSTOMER RECEIPT *a*
Date: 8/82/17 52 Recei CP Drawer: I
pt no; 35313
Year Number
917492817 TECH 28841985 Amount
LILLINGTON, NC 27546
B4 BP - ENV HEALTH FEES
NEW TANK $758.88
JONATHAN TAYLOR
Tender detail
CP CREDIT CARD
Total tendered $758.88
Total payment t750.80
1758.08
Trans date: 8/82/17 Time: 14:38:37
** THANK YOU FOR YOUR PAYMENT as