ENVH RefundHarnett
COUNTY
NORTH CAROLINA
COUNTY OF HARNETT
CHECK REQUEST FORM
Account Number: 110-0000-345.18-00
Project Number
Vendor Name: Atlantic Construction Inc
Vendor Number:
Remittance Address: 7 Doris Ave. E.
Jacksonville, NC 28540
Date: September 13, 2017
FX Mail to payee
7 Check to be picked up by:
(Requires approval of Finance Officer(
Approved:_ Disapproved:
Reason for check request: Both lots have previously been permitted in April, customer requested refund.
This check request has been examined by me and is hereby approved for payment.
Department Head or uulh�oriizzed®Designee Date
Graham H. Byrd, R.E.H.S.�_5'_` ��r— I/S
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
Description
Amount
ENVH Soil Evaluation Fees
17-5-42239- Sweet Water Lot 51
$ 750.00
17-5-42240- Sweet Water Lot 52
$ 750.00
Total Amount Due
i $ 1,500.00
Reason for check request: Both lots have previously been permitted in April, customer requested refund.
This check request has been examined by me and is hereby approved for payment.
Department Head or uulh�oriizzed®Designee Date
Graham H. Byrd, R.E.H.S.�_5'_` ��r— I/S
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
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HARNETT COUNTY CASH RECEIPTS
amr CUSIO4k RLCEIPT eaa
Oper. BPEURICH Type; CP Drawer: 1
Date: 9/11/17 51 Receipt no: 81592
Year Number Amount
2817 50642240
92941 TECH 4
LILLINGION, HC 27546
B4 BP - ENV HEALTH FEES
NEW fAHK $750.08
ATLANTIC CONSTRUCTION
Tender detail
CP CREDIT CARD $758.80
fatal tendered 1758.00
Total payment $758.88
Trans date: 9711/17 Time: 15:34:82
ee THANK YOU FOR YOUR PAYMENT ae
HARNETT COUNTY CASH RECEIPTS
*** CUSTOMER RECEIPT ***
Oper: DPLIRICH Type: CP Drawer: I
Date: 9/11/17 51 Receipt no: 81590
Year Number
2017 50042239
92941 TECH 4
LILLINGTUN, NC 27546
84 BP - EK,
NEW TANK
Amount
HEALTH FEES
$750.00
ATLANTIC CURMUCTION
Tender detail
CP CREDIT CARD
Total tendered
Total payment
Trans date: 9/11/17
1750.00
1750.00
1750.00
Time: 15:33:19
** TT9;NK YOU FOR YOUR PAYMENT **
BP200I01 Harnett County 9/13/17
Application Inquiry 13:03:51
Application number . . . : 17 50042239
Application status, date : CLOSED 9/13/17
Property . . . . . . . . . . : 81 FOLLY CT
PARCEL NUMBER. . . . . . . . : 01-0544- - -0004- -59-
PIN. . . . . . . . . . : 0544-36-9950.000
Subdivision . . . . . . . . : SWEETWATER 71LOTS
Zoning . . . . . . . . . : RA -20R RES/AGRI DIST - RA -20R
Application type . . . . . . : CPSF CP NEW RESIDENTIAL (SFD)
Application date . . . . . . . 9/11/17
Tenant number, name . . : LOT ALREADY PERMITTED17-41034
Master plan number, rev'wd by: F7 BP
Estimated valuation . . . . .
Total square footage . . . . . 0
Public building . . . . . . : NO
Work description, qty . . . .
Pin number . . . . . . . : 381439
Application desc . . . . : 53X40 3BD 2.513A SLAB W/GARAGE
O1
Press Enter to continue.
F3=Exit FS=Land inq F7=App1 names FB=Tracking inq F9=Bond inquiry F10=Fees
F11=Receipts F12=Cancel F13=Val calcs F14=Misc info F24 --More keys
BP200I01
Harnett County
Application Inquiry
Application number . .
. : 17 50042240
Application status, date .
. : CLOSED 9/13/17
Property . . . . . .
. : 97 FOLLY CT
PARCEL NUMBER. . . . . . .
. : 01-0544- - -0004- -60-
PIN. . . . . . . . .
. : 0544-36-9939.00
Subdivision . . . . . . .
. : SWEETWATER 71LOTS
Zoning . . . . . . . . . .
Application type . . . . .
. : RA -20R RES/AGRI DIST - RA -20R
. : CPSF CP NEW RESIDENTIAL (SFD)
Application date . . . . .
. . 9/11/17
Tenant number, name . . .
Master plan number, rev'wd
. : LOT A LREADY PERMITTED 17-41035
by: F7
Estimated valuation
BP
.
Total square footage . . .
. . 0
Public building . . . . .
. : NO
Work description, qty . .
. .
Pin number . . . . . .
. : 432640
Application desc . . . . .
. : 40X42 4131) 2.5BA SLAB W/GARAGE
Press Enter to continue.
9/13/17
13:04:54
01
F3=Exit F5=Land inq F7=App1 names F8=Tracking inq F9=Bond inquiry F10=Fees
F11=Receipts F12=Cancel F13=Val calcs F14=Misc info F24=More keys
Initial Application Dale:
Central Permitting
Application # 1l' J(AJ'i l�D
n i«
wunlI r Vr RP.RNt l I RESIDENTIAL Lr01D USE APPLICATION
108 E. Front Street, Lilenglon, NC 27546 phone'. (910) 8937525 ext 2 Fax: (910) 893-2793
wwlsiI.Inamett.org/permils
"A RECORDED SURVEY MAP, RECORDED DDLLED (OR OFFER 10 PURCHASL) k SI I t PI 1111 ARE REQUIREDWHENSUBMITTING A LAND USE APPLICATION -
LANDOWNER: L -J/ LI LR 5 ► Fr�tc� J- ,z.STo/l j 104** Maihny 7,.1GrL.=:.r
_`�Id
City: Ti9tJi Sa IVUI II 4r State: AIL Zip_,;Q
'�p Contac, No _ L/Q..3��80� Email:.p„7�
APPLICANT'AqAwTL I cte!y'a�-,%J"rA4. Mailing hUJlexs p AoAzi 1 a %e
City: ia OxvWi 1110 Slater. ZiP:. Z5'9C Coularl No [%d•f.�},i'Y.�i Email:I-
*Please 611 out applicant Interma4on a dieerent than landowner • t[,Aq
CONTACT NAME APPLYING IN OFFICE: c�� ZC�m 4,V—_ phone it 9111 336 -)2404L
PROPERTY LOCATION: Subdivision: _ 7 L. e> s� �% . / T , j� _ _ _ _ Lot #: SZ Lot Size: o, JS 3_d%<
Stale Road e2o�f-r� State Road Name: 141, • _.�a1 C�� je�r _ Map Book & Page:g0/% I T-%0
Parcel: 010SDqcoo!F 60 PIN c4'"-.3`-1331, Doo !!
Zoning: ,20 Flood Zone:_ watershed C)kS Deed Soot,R Page-V3�, 0-7441 Power Company':JOe474 AvyiIii. .a&�L
'New structures with Progress Energy as service provider need In supply premise numbw
from Progress Energy.
PROPOSED USE:
� r
SFO: (Size 0,3 x--41) # Bedroorns:j # Baths: Xasumenhwlwo bath Monolithic
__ �daraye:X Deck:_ Crawl Space:_ Slab: Slab:_
(Is the bonus room finished? (__ ) yes (__) nil w) a c4sel5 I _ ) yes (J no (it yes add in with If bedrooms)
❑ Mod: (Size _x__) # Bedrooms_ # Baths_ Basemenl (w/wo balk) I;alage:__ Site Built Deck:_ On Frame_ Off Frame_
its the second flour finished? (_) yea ( _) no Any utlev :atc built additions? U yes C_j no
❑ Manufactured Home: _SW _DW _TW (Size_ >:.
❑ Duplex. (Size _x_) No. Buildings: _ _ 11n Bedmolns Per Unli
❑ Home Occupation: # Rooms: _ Use _ _ _ Hums ni r
❑ AddthordAccessory101her: (Size _x� Use:` _
G;arage:_(site built?---) Deck:_(sile built?_)
#Employees:_
Closets in addition? U yes (-j no
Water Supply: County Existing We _New Well (# nrdwrllmps uvnu+:'ll __ __) 'Must have operable water before final
Sewage Supply: -X- New Septic Tank (Complete Checklist) _ Lxisbng Sepur. 111 'It li;onnplete Checklist) _ County Sewer
Does owner of this tract of land, own land that contains a mat ulach veil home wilhm 1111., rnu„hed feel (500') of tract listed above? (—) yes (JC_J no
Does the property contain any easements whether underground ni ov�erh`eaadd�I /, y, -s no �rYpitYlolpt, CMCVYj,4
Structures (existing or proposed): Single family dwellings:__ / OYvyWryi�nulac4 u�r� lIniues: 7711 Other(speGty):
Required Residential Property Line Setbacks:
Front Mlnimum-.&,�— Actual -
Near �� t
1
Closest Sine L
_/_
SideslreeUcomer lot Gy _
Nearest Building 10
on same lot _
Couunont::
Api-I +•.n7KIN i.01vlTlwl,b SACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGION: _ —',,o
Ga-. Lir ry v'f Ld,/1_ �s,g s Rel
itis, iy .LST 01' r
rh�ay —fig—Qn.%— /ioin..n.ikErz
5T
Gi- a1 �o�l� 'F•
II permits are granted I agree to nform to all ordin ces and laws of the Slate of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that fXoregdng S Bments ac d correct in the bast of my knovAadye Permit subject to revocation if false information is providedUate.
`•/ 3ignatu of ror Ownor's Ayent
"9t Is the ownerlappitcants 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 applicstions."
"This application expires 6 months from the initial date if permits have not been issued"
J
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PROPOSED
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--- ------ -- 510'0257"£ 90.00' -
FOLLY COURT
40' PUBLIC R/W
PLOT PLAN
PROPERTY 0F: ATLANTIC CONSTRUCTION 114q�NS%A CAR
9DD$E@: 97 FOLLY COURT .•FES8% .x4 % TOWNSHIP: STEWARTS CREEK
CITY: LINDEN, NC�v- = DALE: AUGUST 29, 2017
.tl SEAL r'. -
COUNTY: HARNETT = 'r L 4491 a• - SCALE: 1a' = 40'
'y�' Jam' = REFERENCE: LOT 52
TAX PIN: 0544-36-9939.000 ' y �� SUR�'--,;� SWEEETWATER SUB
MAP # 2011
PGS 470-475
�. frtAa.S MICHAEL . ADAMS PLS -L-4491
CFS NC -075
Y.---- SURVEYING. INC.
U' -Rn C-2589
ISOB FORT BRAGC ROAD .. ., .. ..
FAYE"EVILLE, NC 28305 t ...r i rc. "a. nx: •.r fu
(RIRIFul r .. ' .. .. r ... �.
�� � ue PSSUR'/E YINNGPgNC RR.COu � ... m..[ �i o- x, n.
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ON A
SUBDIVISION PLAT "" "" "°""
MILL Luw nn ien mwl ouafon. avamnlLRvc
.,�,an�,�JJ _ a'" • � noch
FOR i
rv.auenwuan,w rmanu. rviAx wit
! R,L _ Engineers, P.A.
r SWEETWATER
vt>�rm.urnoxs.aa: wtw x a=r Caunarvn Exa=iwei Suavern¢s
H r.o soa+rs :vnn.rma•.+m �. nee�w.�� nye
CT TAf)TVT.QInv
DIVERSIFIF_D INVESTORS INC.
AO. BOX 1685 - 405 JOHNSON BL VD.
JACKSONVILLE, NC 28540
(910) 346-9800 - FAX (910) 346-1210
E-mail:
July 21, 2011
Re: Sweetwater Subdivision — Harnett County, NC
To Whom It May Concern:
As the developers of Sweetwater Subdivision, we have granted Atlantic Construction Inc., to
construct single family dwellings in the subdivision project.
Should you have any questions or need any additional intbrmation concerning this authorization.
please do not hesitate to contact me.
Sincerely,
Betty Bullock, President
DIVERSIrIED INVESTORS INC.
bb
NAME: _-r • _ APPLICATION q:_ anDg?G. O
*This application to Itc filled (Fiji when applying lar a septic system inspection."
County Health Department Application for Improvement Permit and/or Authorization to Construct
IF THE INFORMATION IN THIS APPLICATION 1S FALSIFIED, CHANGED, OR THE SITE IS ALTERED, THEN THE IMPROVEMENT
PERMIT OR AUTHORIZATION TO CONSTRUCTS) IAL I- It ECOME INV ALID. The permit is valid for either 60 months or without expiration
depending upon documentation submitted. (Complete site phut = (F0 n oilihs; ('ongdctc plat = without expiration)
910-893-7525 option I CONFIRMATION
�{ Environmental Health New Septic Sys 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.
• It 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.
• 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 and of recording for proof of request
• Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
C Environmental Health Eirlstino 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 8 select notification permit
if multiple permits, then use code 800 for Environmental Health inspection. Please note confirmation number
given at end of recordino for proof of request.
• Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting for remaining permits.
anrrit,
If applying for authorization to construct please indicate desired system type(s). can be. ranked in order of preference, must choose one,
I—) Accepted 1-1 Innovative Al
Conventional I _) Any
1-1 Alternative I_)
The applicant shall notify the local health department upon submittal of [tis application if any of the following apply to the properly in
question. If the answer is "yes', applicant MUST ATTACH SUPPORTING DOCUMENTATION:
(_)YES (,X)NO Does the site contain any .lLIT isdictionalWetlands'!
I—)YES JK) NO Do you plan to have an irli •a',trQ sJll now or in the future?
(OYES (A) NO Does or will the building contain any drams'! Please. explain.
I—IYES I-1 NO Are there any existing wells, springs, w•atetlincs m Wastewater Systems on this property?
(_)YES I-!) NO Is any wastewater going To la: generated on for mic other than domestic sewage?
(_)YES {XI NO Is the site subject to approval by any other Pubhr xgemcy'!
IXIYES I—) NO Are (here any Easements of Right of Ways on 0w propeny?
(_ IYES (X) NO Does the site contain any existing water, califs. phunr or underground electric lines?
If yes please call No Cuts :n MM -632-4949 to Ini aw the lines. This is a free service.
1 Have Read This Application And Cerltfy'1'hat'rhe Information Provided Herrm Is'1'rue, Complete And Correct. Authorized County And
State Officials Are Granted Right Of Entry To Conduct Necessary Insim•rlion+'l n Delernine Compliance With Applicable Iaws And Rules.
1 Understand That 1 Am Sole1 •sponsible ForThe Propel Identificalion And I alieling Or All Property Lines And Corners And Making
The Site Ace 'ble at omplcle Site Evaluation Can lie Perlbrnn•A
al'ROI'ERTY OW :R OWNERS LE(:AI. REPRESENTATIVU SIGNATURE (REQUIRED) DATE.
11100
Initial Application Dale. I 1 I 1
Application #
r, ,w
`.V711 Vr NAKI t I RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lilhnglon, NC 27546 Phone. (911) Frl7'7521, ex1:2 Fax (910) 893-2793
www. hamett.org/permits
"A RECORDED SURVEY MAP, RECORDED.DDIEEU (oR OBER 10 PURCHASL) s Sill PI 1114 AR(, RLQUIREO WHEN SUBMIEfING A LAND USE APPLICATION'
LANDOWNER: t.-+/ li eR $ I J-'� J -N ✓ STuQ$11aj[,Maihng Addn•:. P
City: - jk SOIVV J 1 Q StateN Zi r
--� P:,;,� Q Cconlacl Nn �%fQ/�.3 �/9O4 Ernst]: _Ute ,6 �D
APPLICANT': % TL l L41L5f49t.%J5'lr_.e�e, Mailing AUtlress —___7 /Qpgt} �(i� ,
A'
City: Clap.vui �Il Stale:/ALt_ Zip2030+ Col aw,t No Ernail:
'Please fill out epplrcent inlormelion it different Then landowrer
CONTACT NAME APPLYING IN OFFICE:_ _ _ ZC��M Phone #e
PROPERTY LOCATION: Subdivision:7 L,� ea v % (�_/¢S� j� _ Lot C If Lot Size: Qr �J AC -
Stale Road # .Z O State Road Name: 46114 e.i Cd 5 Rt„ _ Map Book 8 Page:�Q
Parcel:0/OS�+t GDO¢ 9 PI(v_O S'fy--3(,- 99SO. 000
Zonlng:&-204 Flood Zone:_, Watershed:_ _ Deed Book A Page Por Company':
-___ %
UYAOJL
'New
structures with Progress Energy as service provider need In supply prelrnse numM:,
from Progress Energy.
PROPOSED USE:
�/ Monolithic
SFD: (Size�x0� # Bedrooms:3 # 8aths:'l fiBasen,enUw/wo baRO.___ scraye., Deck:_, Crawl Space:_ Slab: X Slab:_
(Is the bonus room finished? L -_l yes () no wl a cl, t -I ( _) yes U no (if yes add in with #bedrooms)
U Mod: (Size _x� # Bedrooms_ # Baths_ Basement (w/wo bath)_ _ t;reaye:_._ Site Built Deck:_ On Frame__ Off Frame_
(Is the second floor finished? (._ _) yes I—) on Any usher dile built additions? (_j yes (__) no
U Manufactured Homo: _SW _,DW _TW (Size__._ _ __) # Bedmun,s Garage:—(site built?___j Deck:_(site built?_)
U Duplex: (Size _x__) No. Buildings:___-__ Nu. HedrOoms Per 11.111
U Home Occupalion: # Rooms: Use , 11,,,,,; ,,; 1,o01;
#Employees._
U AddihonfAccessorylOthec (Size _x_� Use:_ Closets in addition? (._-) yes L_) no
Water Supply: -It County _ Existing Well _ _ _ New vv1:11 (# of dwellings usnm ,von ) *Must have operable water before final
Sewage Supply: X- New Septic Tank (Complete Checklist) _ _ I'xisling SEpih. Ivo: ((:anplete Checklist) _ County Sewer
Does owner of this tract of land, own land that contains a manuladu-,�) home widnu Inn- o 1,11ed [Let (500') of tract listed above? L-) yes (✓no
Does the properly contain any easements whether underground n, ove)h0au I pi . 11„ orlai-Aa ! Oiyr.Lrit
Structures (existing E9
:Single family dwellings:___ _ / _ __ _ Manulw.hn,1 -111Cs 011ier (specify):
Required Residential Property Line Selbacks
2 t
Front Minimum 3S Actual 31.jo
Hear 5 ,�jdirl
6
Closest Side _ _10 is k pr
SidestreeUcurner lot LLJ
Nearest Building
on same 101
Conuoenfs:
APF n :r'i Ipld ,.ON11bh n-. • BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGI iRa: _ _ �p w / /L -
0q,u T Oni t o -V _ Pq e ecru dla a
_u
Tota ry ,LSTy . l D 17'-1,4 / _t d
_.77!iln I,_--2zlQ--,-/�.v�.vmiakslz
7"ti Lev &EAW9 T o" To _ fp!/� _ c j,
If permits ere granted 1 agree to cool to all ordinances and law;: of the State of Nnnh Jnwknu regulating such work and the specifications o1 plans submitted.
I hereby stale that foregoing stats is area rmrl t the hest of my knnwlerige Permit subjeci to revocation if false information is provided.
XSlgnatu f e or Owners Agent - Date
'It is the own8dapplicants 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 rt:da if permits have not been issued"
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43 a°
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aFP2011 -470/05
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4aP/2011-470/475
SWEETWATER SUB,
MAPP2011-470/475
co
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PROPOSED
HOUSE
E_ -CHRISTIAN" $
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qba
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CRMO ,
MrvE p
4 WAfX
_ C1 l
—S 10'02'48 "£ 74.26' --
i FOLLY COURT
40' PUBLIC R/W
PLOT PLAN
PROPERTY 0F: ATLANTIC CONSTRUCTION INCA.
ADDRESS: 81 FOLLY COURT \p`�Q•�H CARO( TOWNSHIP: STEWARTS CREEK
p .'FESS%p •,ti
CITY: LINDEN, NC� 2;Qp y9.• DATE: AUGUST 29, 2017
COUNTY: HARNETT = .n SEAL * :- SCALE; t" = 40'
_ c..
TAX PIN: 0544-36-9950.0009yFERENCE: LOT 51
14!AAFF''��•� SUR-` a*' SWEEETWATER SUB
. oPF.' MAP M 2011
L' ,[( PGS 470-475
MICHA., J. AOAtK PLS -091
NC -075
NC -075
-fP>x
aa.P. S.IN
5VLYG. INC NOTES
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SUBDIVISION PLAT
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SWEETWATER aR��
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UBDIVISION
NAME: _ -- APPLICATION#: (—5bD4V 1
'This application to be filled out when applying fora septic system inspection.*
---------_•--•-••••,..•..�n,a(rasu,cnnrv(Jhl).ONTHESITEISALTERED. THIN THEIMPROVEMENT
PERMIT OR AUTHORIZATION TO CONSTRUCT SHALL nECOMti INVALID. The permit is valid for either aonths or without expiration
depending upon documentation submitted, (Complete site plan = 6(1 na)nths: G,mplete plat = without expiration)
910-893-7525 option I CONFIRMATION 01�,
Environmental Health New Septic SvstemCode 800
•
At properly irons must be made visible. Place "pink properly 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 Ilags 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 ttp Addroee.A u nita. fn r.. 1-..- _,._
•
After preparing proposed site call the voice system y lto YV•,,,r le and
use
800 (after selecting notification permit if multiple permits exist) for Envi Environmental Health inspection. Please not
confirmation number given at end of recording for proof of request.
• Use Clrck2Gov or IVR to verity results. Once approved, proceed to Central Permitting for permits.
❑ E'nvironmenta/HeaBh E1rlaNna Tank nspechons 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 (it
•
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 a1 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 re
R to hquest.
• Use Click2Gov or IVR results. Once approved, proceed to Central Permitting for remaining permits.
SEPTIC
if applying for authorization to construct please indicate d.11:sired system rypct, i. can be. ranked in order of preference, must choose one.
Accepted 1-1 Innovative ' 1 Conventional L.. 1 Any
I—) Alternative I_) Other___
The applicant shall notify the local health department ulu,n Submival 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_.)YES
I.O NO
Does the site contain any Jursdiciional Wetlands:'
(OYES
41 NO
Do you plan to have an iilkLliuttsysfem now o, In he future?
I—) YES
(1i) NO
Does or will the building contain any dptihs'1 I'leaw explain,
I—IYts
11- 1 NO
Are there any existing wells. springs, 'vote, finw..a Wastewater Systems on this property?
I_IYF.S
(X) NO
Is any wastewater going to tic generated on thr mw other than domestic sewage?
I__)YES
1)i') NO
Is the site subject to approval by :my other Public Agency?
(1IYES
I—I NO
Are there any Easemeu+s o, Right of Ways on chis pn,perty?
(_IVES
1XI NO
Does the site contain anv exi.s(iug wale,, cable. Ow"k- ur underground electric lines?
If yes please call No Cuts al SINI 632 4944 to i.,, ,Ic the lines. This is a free service.
1 Have Read This Application And Certify'Thal The Information Provided 11rraiu Is True, Complete And Correct. Authorized County And
State Officials Are Granted Right Of Entry '1'o Conduct Necessary Inxpertioun lo Determine Compliance With Applicable Luws And Rules.
1 he Site
eland That 1 Am Solel expansible For Thr Prulmr ideuliticalion And Labeling Of All Property Lines And Carriers And Making
The Sile xslb , T A .omplele Site Evalnulioa Can Be Perloruird.
PROPF,RTY OW E OWNERS LEt;