DOCUMENTS Initial Application Date: Q•S17 .YI V 1 — Application# I c Sbv l I c
CU#
Central Permitting 108 E.Front Street,Lillington,NC 27546 . Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.hamettorglpermits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER: TOIOets S. So.in Mailing Address'. 3873 *0.44•1
City: FqS a'i at. State Zip.DA30 Contact No: 4/o•63V (.lL4 Email: 7LS.Jnlwlogssirsae.00,.
APPLICANT': Mailing Address:
City: State. Zip: Contact No: Email.
`Please 01 out applicant information If different than landowner
CONTACT NAME APPLYING IN OFFICE: T Jyln S. A..' Phone# 110. 4 75--41L4
PROPERTY LOCATION:Subdivision. Lot#: Lot Size.46. 96 coal
State Road# i^' 1 'A 1 State Road Name: Waffles Map
Map Book&Pager 12.;a..;a.Parcel: OLD IS6lo bCib & bl PIN: SC(lo CI'1 4'l3S'uc»
&.10ZoninorrOtA Flood Zone: X Watershed: A)A Deed Book&Page: 3 So11 1-i23 Power Company*: fink.. _email
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
loIlolIth iC
SED:(Size 5rx 64 )#Bedrooms'. 3 #Baths:2JBasement(w/wo bath).fJ Garage: / Deck:_ ,Crawl Space:✓Slab: Slab:_
(Is the bonus room finished?(rl yes ()no Nl a closet?(_)yes (./J no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms #Baths_Basement(wlwo 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: (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. County Existing Well /New Well(#of dwellings using well 1 )'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 (i{no
Does the property contain any easements whether underground or overhead(L)yes (_)no
Structures(existing or proposed):Single family dwellings:✓iks NO. Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments: Finavl k..... as 44a L.44 ely e/
Front Minimum 35 Actual .i rend is /45—
Rear
45Rear 3s /88
Closest Side /01 /041
SidestreeVcorner 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: la,t4 i3.-'ls} en yZi Do Ma.Q40.-4.s �1,wnn.
Tw/n - i, an $- lax' 6+ in Urfa i:^4. ta
eno:n. rn sag a+ ply /54.0 :n An/-
ATog .n old ?n+ Rd. Torn /LILA ea igketen A/. heti is Arrow. /.Sw41
SOS, in g
•
If permits are granted I agree to owe 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 stair, is are accurate and correct to the hest of my knowledge. Permit subject to revocation if false information is provided.
Signature of Owner or Owner's Agent Date
"'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 issue*
Residential Land Use Application Page 2 of 2 03/11
Harnett County Department of Public Health
Well Construction Permit Application
If the information in the application for a Well Construction Permit is falsified,
changed, or the site is altered,then the Well Construction Permit shall become
invalid.
APPLICANT INFORMATION
5seen S. &:+ ( ffro ) 431 -4224
Applicant/Owner Phone Number
3853 er.aaj Igd(, Fyexe.4e Ax. .tont-
Street Address, City, State,Zip Code
The Applicant must submit a Site Plan. The Site Plan is a map/drawing of the property and must show:
I.existing and/or proposed property lines and easements with dimensions;
2.the location of the facility and appurtenance;
3.the location for the proposed well;
4.the location of existing or proposed sewer lines and/or sewage disposal systems within 100 feet or the proposed well;
5.the location of any existing wells within 100 feet of the property,surface water bodies;
6.above ground and/or underground storage tanks;
7.and any other known sources of contamination within 100 feet of the proposed well site.
The Applicant shall notify the Harnett County Health Director through or by way of the Harnett County
Division of Environmental Health if any of the following occur prior to well construction:
I.there is a relocation of the proposed facility;
2.there is a change in the intended use of the facility;
3.there is a need for installing the waste water system in an area other than indicated on the well permit;or
4.there are landscape changed that affect site drainage.
Contact information: Environmental Health Division- 910-893-7547
PROPERTY INFORMATION
Proposed use of well
Single-FamilyV Multifamily- Church ._ Restaurant H Business H Irrigation
Street Address 1... ktr•4..rTh (7.1)1 Subdivision/Lot#
Parcel# OH> 1 5N\b OAta3 U1 PIN# oT94 - fl - Y93r- oo4
Directions to the Site
I have thoroughly read and completed this Application and certify that the Information provided herein Is true,complete and
correct to the hest of my knowledge and is give in good faith. Representatives of the Harnett County Health Department and
state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable rules.
I understand that I am solely responwbledor the proper idennt ca ion and labeling of all property lines,underground onlay lines,mid
making the sl�essihle so that a will can be properly renin,led according to the permit
Jr" -l9
coy Owner's oftxnee s Legal Representative Signature Required Date
„siost.‘ Town of Erwin
Permit#
F , Zoning Application & Permit
eal Planning & Inspections Department
Rev Sep201a
Each application should be submitted with an attached plot/site plan with the proposed use/structure showing lot
shape,existing and proposed buildings,parking and loading areas,access drives and front,rear,and side yard
dimensions.
Name of Applicant =ppm E a..in Property Owner -rows. + k6:f.,y a..,n
Home Address ,W. 1 rJ 3$;3 giant 1641a14ome Address k' e4.. AS
City,State,Zip t{6++—/##e- ray. ,, 3832 City,State,Zip Fiwln t 0 c
Telephone 410_test•L3.i4 Telephone to_43f-41.ue
Emaill6aiato04.1+.lpwnu.o.n Email Tar:-.2alits r;rift a.a....
Address of Proposed Property Witten tld 1 V.$ 1C
n 1 a
Parcel Identification Number(s)(PIN) 105%.cri • ear-D O Estimated Project Cost
What is the applicant requesting to build /what is lit. l"'”;61 8*' •
the proposed use of the subject property? Be specific. wasFm.s fa.nh.efta n.
Description of any proposed improvements
to the building or property
What was the Previous Use of the subject property? 6+41
Does the Property Access DOT road? alis
Number of dwelling/structures on the property already p Property/Parcel size Gay 044R4 _ 67.9'
Floodplain SFHA Yes ✓No Watershed Yes ,/No Wetlands Yes JNo
MUST circle one that applies to property Misting/ ropose Septic ys em Or
Existing7PThriosedwer
Owner/Applicant Must Read and Sign AA
The undersigned property owner,or duly authorized agent/representative thereof certifies that this a licltiorA lFeTorgoing
answers,statements,and other information herewith submitted are in all respects true and correct to the best of their knowledge
and belief. The undersigning party understands that any incorrect information submitted may result JAWtiv2caIYof this
application. Upon issuance of this permit,the undersigning party agrees to conform to all applicable town ordinances,zoning
regulations,and the laws of the State of North Carolina regulating such work and to the specifications of plans herein submitted.
The undersigning party authorizes the Town of Erwin to review this request and conduct a siiFe iPrit®ttifR
r . t..�
to this a• •lication as a. •roved. ua
TsepL a.:.. . e..----._.. 8-2-/3
Print Name : gnature of Owner or Representative Date
For Office Use
Zoning District 4--10
Existing Nonconforming Uses or Features I /WIC `/
Front Yard Setback 311 Other Permits Required _Conditional Use Cuuilding _Fire Marshal/yOther
Requires Town Zoning Inspection(s)ct _Foundation )(Prior to C.of O.
Side Yard Setback /Os Zoning Permit Status ^Approved Denied
Rear Yard Setback 3 S' Fee Paid: b/0. o,' I Date Paid:fp_ 11
Staff Initials.
Comments Z0/11.15 ✓471 f{ 16'413% l n T-44,-.-05 o IJet do A Qe'/e kW
Signature of Town Representative: (2i-p.ac•i --te& ,(Q--r. . teA raved/Denied; e9, /I—)--__ _ _ ..
W:
243.73' 303.0['
3 lab'
Parcel 'L, -
FIP N ( ' .�) Acres'Total
m o 6
4 tm- - 0. Ac in SI: 1741
- 0.57 Ac in Poser Line
N N Cis FAcre Nei
Parcel ..4.. I '. 12 wilt da.--/
3.13 Acres / I1 P.
1,
\ Total 302.57' h
TOG N )3' 18" E (1
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to
7 1
0 Is' 'Rork( l:4e
-aura II {
Woad Fence
24&9T °
Set Fat Nell dl
94' 32" W 305.91' / .SIP 1.h Ir ..,' Q 1,S' rM. elft H p
Fonts 4S r .•PONt' ddw NV-r 4. eft IF'
South o' Lino 1
'acheI Miller 15 \ i
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oak 412, Page 666
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3 eom45.04 Acres
- 0.21 Ac in SR 1741
Wood / 111
- 0.57AcInPOWS? Line {
! 426 Acre 14E7/ 11
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60' R/W FPKN 96,06: . CP CP. 101.93'- CP I CP
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NAME: -Tpco?is & n 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 TI{E 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*
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 aVfor 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 underarowth 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 alter 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 I 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.
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 beck 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 I & 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 typetsl: can be ranked in order of preference,must choose one.
1—I Accepted I ) Innovative II Conventional (#I Any
I—I Alternative lI 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—IYES I /(NO Does the site contain any Jurisdictional Wetlands?
{ IYES { 1 NO Do you plan to have an irrigation system now or in the future?
I_ J YES I I NO Does Or will the building contain any drains'!Please explain.
}YES -"I I NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
(_}YES NO Is any wastewater going to be generated on the sue other than domestic sewage?
LI YES I L1 NO Is the site subject to approval by any other Public Agency?
{V7 ES { NO Arc there any Easements or Right of Ways on this property?
f/I YES ( I 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
Stale Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I tlnderstan That I Am Solely Responsible Fur The Proper Identification And Labeling Of All Properly Lines And Corners And Making
The Sit cesslhle So That A Complete Site Evaluation Can Be Performed.
8-2- 14
OPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10110