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DOCUMENTS
Initial Application Date: 11 IlD/ f / Application a L /5t11.44g,121 I CUM COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION Central Permitting 108 E.Front Street,Ullington,NC 27546 Phone: (910)693-7525 ext:2 Fax:(910)893-2793 wvn harnett.org/permits "A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION" LANDOWNER: ,h.AI \l cLA M 'uqY r I nct(Dri Mailing Address: P 0 (3flLt. 9 `] 6 City: 1'7 r{1 CLA 14.1e2 ti State:N L7ip:),-17R()rj Contact No: /� t� Email: APP❑C(A�NT': .Ib1-V&- O rinks Mailing Address: P 0 I-�0 1. d 7-..- City City. C]Y( t I vs.,.Li Staten zip:J'.7CSS Contact No4i9) 9Ocz 46(09 Email: 1}iot In O D ntrJtj a7 `Please fill out applicant information tlifierent than landowner LU In n-hr¢gyn. yam{' CONTACT NAME APPLYING IN OFFICE: Phone M PROPERTY LOCATION:Subtllvision: /� Lot M: LotoTSiizee. 5 Or V 4Q(Ve State Road M State Road Name: M4- L ' S q Lai C h kAy r h IC nad Map Book 8 Page:ab I/. 3 Parcel: J '79 1a 9 Cl h0 a.4 Cl J. .s �l PIN: 9 tpq -- 4a.'-,z3_ug4. De-Jo Zoning:PE Flood Zone: P Watershed: KT Deed Book 8 Page: YO / Weft Power Company': 'New structures with Progress Energy as service provider need to supply premise number from Progress Energy. PROPOSED USE: f11II Monolithic SKI:(Size TG x SOI M Bedrooms&M Baths&.Basement(w/wo bath):_Garage: ✓ Deck:_Crawl Space:✓Slab'._Slab:_ (is the bonus room finished?U yes U no w/a closet? ( )yes U no(If yes add in with M bedrooms) Mod:(Size x h M Bedrooms_M Baths_Basement(wAvo bath)_Garage:_Site Built Deck:_ On Frame_ON Frame_ (Is the second floor finished?U yes U no My other site built additions?U yes (U no ❑ Manufactured Home:_SW_DW TW(Size x le Bedrooms:_Garage: (site built? )Deck: (site built?_) ❑ Duplex:(Size_x )No.Buildings: No.Bedrooms Per Unit: ❑ Home Occupation:M Rooms: Use: Hours of Operation: MEmployees: ❑ Adtlibon/Accessory/Other.(Size x )Use: Closets in addition?U yes ( 1 no Water Supply: ✓ County Existing Well _New Well(M of dwellings using well )%Mutt 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 and,own land that contains a manufactured home within five hundred feet(500)of tract listed above?U yes ( )no Does the property contain any easements whether underground or 9verhead U yes (J no Structures(existing o proposed): ingle family dwellings: 4nufactured Homes: Other(specify): S � �.&�� Required Residential Property Line Setbacks: Comments: 1)11k-D— CILJ./JIC'ILLKs . L.S On Front Minimum Actual I AS' Q Y e---10{c Rear _, 7 S1Q ( DDD .Closest Side O 0 0 asVeeVcorngr lot Nearestotltling on same lot Residential Land Use Application Page 1 0l2 03111 APPLICATION CONTINUES ON BACK SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINOTON: / W ICQ J ', I �. T L`v n [71-. _t 1 .l 4-. Y I s ct r'1 l�h u Y r Y� p tl /1 �1 . �O t cnn If permits are granted I agree to conform to all ordina es and laws of the State of North Carolina regulating such work and the specifications of plans submitted. I hereby state that foregoing state nts are ecce and Imre to the best of my knowledge. Permit subject to revocation If false Information Is provided. E-1 (0- ;An Signature of Owner or Owner's Agent Oats "Mt 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 S months from the Initial date If permits have not been issued" Residential Land Use Application Page 2 of 2 03/11 E,,', a V (D m m -4 x,--, r1 O o -10 O _ r a w z L — N n / 3 / m _, 1 Y K • L \V / - Cr t ): i t 7, v I O c 1 c ja 3/4h I x / 11/4,. / 1 s "G+2 G 4 file,lir1n'j/ 11 , %4 Harnett County GIS 2076 / o' t • 1 J 2195 - i J S WpJ s F wj - ) 3131 G i 1 t1ttf1 ' �I :a, j • LEGEND /1 Recycle Center o+E GIS/E-911 Addressing '' Landfills I_ n=MY,J August lb,2017 • Surrounding County Boundaries -03' --— 1inch=300 feet Federal Properly Harnett County GIS r___ 0,..,„„.. , 2076/ 131 DI / / r .7/7 J ✓ 2195 e' i J &L M. ' 3131' \ I I F �� R539 IICO/ ]135 ''N.\5.. *I; v. : 2302 i7- iI 3169 1055 s ,. 1 -•_.- __ _ __ __ -M(ARillllµMier' 19e9 Recycle L ntr ® Surrounding Mainly Boundaries Address Numbers MeleMoade us Landfills Federal property © Ain— — kits slate ZYr e I Oily Limits mm NC Mirc1 _ GIS/E-911 Addressing I� August 16,2017 1 inch=608 feet NAME: 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 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# D Environmental Health New Sentic Sv$temCode 800 • All property Irons must be made visible. Place 'pink property flags" on each corner iron of lot. AU 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 alter confirmation.$25.00 return trio fee may be Incurred for failure to uncover outlet lid. mark house corners and tycoon!,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. ❑ 5nvlronmental Health Eristine 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 hack In place. (Unless Inspection is for a septic tank in a mobile home park) ::11(0140T LEAVE LIDS OFF OF SEPTIC TANK • After uncovering outlet and 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 oroof of request. Use Click2Gov or IVR to hear results.Once approved, proceed to Central Permitting for remaining permits. SEPTIC v If applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference,must choose one. {_I Accepted (_) Innovative {✓ Conventional (_) Any [_I Alternative (_I 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: [_IVES (x) NO Does the site contain any Jurisdictional Wetlands? (_IYES [3( ) NO Do you plan to have an irriaation system now or in the future? (_)YES {k I NO Does or will the building contain any drains?Please explain. IIYES l l NO Are there any existing wells,springs,waterlines or Wastewater Systems on thisPe Y ro rt ? P [_IYES "[�Xyy ) NO Is any wastewater going to be generated on the site other than domestic sewage? {—I YES C11 NO Is the site subject to approval by any other Public Agency? (_)YES fat NO Are there any Easements or Right of Ways on this property? {_)YES {XI 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 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 Com fe Evaluation Can Be Performed. 1 - IG -/r1 PROPERTY OWNERS OR o RS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE 10/10