LAND USE c, L 20
Initial Application Date: ( — ✓ � Application # /
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting <4? 108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 Fax: (91 893 -2793 — www.harnett.org /permits
LANDOWNER: ' j 41+401 ]]�� y / ye; Mailing Address: �) gel i?. l'E'y 2'
City: 6.0 'h State:/v =c. Zip)) )V) Contact # 7/ C > Email:
APPLICANT*: <el Ale Mailing Address:
City: State: Zip: Contact# Email:
'Please fill out applicant information if different than landowner J�
CONTACT NAME APPLYING IN OFFICE: Ay / 1 r° , / v� /�1
/ C -t'le. / Phone # [
PROPERTY LOCATION: D Subdivision: PA /,� a jyi Z 1 ,[�1.�`�' �. Lot #: /4 Lot Size: /
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State Road # // B n State Road Name: A11/ / Map B000k &Page:/(1Ef om
Parcel . A 7 /,/ (� 10 ✓ L 3 2 ` PIN: /4 /D — 4< - 7h , J�J
Zoning: /7k 'v.R(od Zone: �i Watershed: L` )
Deed Book &Page: l/S l ` ]L° 7 Power Company':
'New structures with Progress Energy as service provider need to supply premise number _I from Progress Energy.
SPECIFIC DIRECTIONS TO T T / HE PROPERTY FROM LILLINGTON: l at M1 is P [ L i ) f (7 (44rC1 Dun 7)
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PROPOSED USE:
Monolithic
❑ SFD: (Size x ) 4 Bedrooms:_ # Baths:_ Basement(w /wo bath):_ Garage:_ Deck:_ Crawl Space:_ Slab:_ Slab:_
(Is the bonus room finished? (_) yes (_)no w/ 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: (site built ?_)
❑ Duplex: (Size x ) No. Buildings: No. Bedrooms Per Unit:
t ❑ yome Occupation: # Room • Use: Hours of Operation: #Employees:
Addition /Accessory/0 r: (Size 14 x (y ) Use: S hit* 5 14 Closets in addition? (_) yes (
Wa er Supply: County Existing Well New Well (# wettings using well )'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 (_)no
Structures (existing or proposed): Single family dwellings: Manufactured Homes: Other (specify):
Required Residential Probesy Line Setbacks:_ Comments:
Front Minimum Actual 3 ``//7�
Rear /-4
Closest Side G
Sidestreet/corner lot
�6 -
Nearest Building /7
on same lot
If permits are granted I agre -19 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 coves t to the best of my knowledge. Permit subject to revocation if false information is provided.
y -79 /a a i �
Signature of Owner or Owner's Agent Date
"This application expires 6 months from the Initial date If permits have not been issued**
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
Residential Land Use Application Page 1 of 1 07/10
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NAME: APPLICATION #: /// 2 Z 707
*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 1 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 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 recordina for proof of request.
• Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
❑ Environmental Health Existino 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 back In place,. (Unless inspection is for a septic tank in a mobile home park)
• , DO NOT, LEAVE LIDS OFFOF 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
(liven 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.
( _} Accepted ( Innovative {_) Conventional (_} Any
(_) Alternative (_} 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:
{_)YES {_} NO Does the site contain any Jurisdictional Wetlands?
{_)YES {_} NO Do you plan to have an irrieation system now or in the future?
1_) YES {_) NO Does or will the building contain any ? Please explain.
I — I YES f NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
(_)YES 1.,.._) NO Is any wastewater going to be generated on the site other than domestic sewage?
(_) YES (_} NO Is the site subject to approval by any other Public Agency?
{_)YES {_) NO Are there any Easements or Right of Ways on this property?
(_}YES {_) 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 Si essible §o That A mplete SI "'nation Can Be Performed.
PRO ERfiY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
10 /10
How to Properly Mark Property for Soil Evaluation
(MUST MATCH SITE PLAN)
ink flag
i iron
orange flag
se pink flag
n k fl
House
flag
tramp flag
pink flag
iron . iron
ROAD
DIAGRAM OF A TYPICAL SEPTIC TANK
El • . LID
0
POSSIBLE POSSIBLE
HOUSE HOUSE
CONNECTION
H CONNECTION
POSSIBLE
HOUSE
CONNECTION
POSSIBLE LID SHAPES
l I SQUARE (SHOWN ON DIAGRAM)
I RE CTANG LE (OLDER TAN - ROUND
•