DOCUMENTS Initial Application Date "t ' 13 J 1 '1 Application# I 1 S CO 4-14-.) ,--.8fic
cU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 ex1:2 Fax (910)893-2793 www.harnett org/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)8 SITE PLAN ARE/ REQUIRED WHEN SUBMITTING A LAND USEAPPLICATION**
LANDOWNER. ^A Salk (♦y Si ■e ' Mailing Addresss(!TA fn p1 T A�^ Roc P
City. t II I/Iy 1(�y/�'�j��\fl�y�.� State(:l�\1L ZLpih .i e.ntactNRIC• I r_/_C-I )7 I�Email. �_
APPILIIc�AN11TtJO JSO TT'� I111 `tV Q M/�a�iilliingg Aid/dress+ at •/ • _ ./�/�.
car u �l111 State., Zip'Q {,T—IF�ontact No'1 (S/ �i a. mail. IAA
'Please Gil Qui applh Iron if different man landowner ,�-,, X1/
CONTACT NAME APPLYING IN OFFICE:• T ( A.-Tx(Inc _ Phone# glom-I-11319
PROPERTY LOCATION:,Subdivision. Lot#1(..-0-A Lot Size. I
-61
State Road# VS I 4 State Road Name. \ Rs cis- g[( Map Book 8 PageaO�l/ to c
7
Parcel j p t.02 I y1,l sIt PIN. 01/4.0a1 — sal —cSlS• e.tCSO
Zoning 'Y Flood Zone: X Watershed. I,‘ii Deed Book&Page. SYS y 41V3 Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monoliths
❑ SFD.(Size_x )#Bedrooms:_#Baths Basement(w/wo bath)._Garage Deck: Crawl Space:_Slab: Slab.
�z (Is the bonus room finished?((_)yes ( )no w/a closet?( )yes (�)no(if yes add in with#bedrooms)
x0 Mod:(Size Lg1 x_941)#Bedrooms#Baths_,.Basement(wNio bath)_Garage:_Site Built Deck:_ On Frame_Off Frame ✓
(Is the second floor finished?( )yes (_)no Any other site built additions?(J yes (_)no
❑ Manufactured Home _SW_DW_TW(Size x_)#Bedrooms. Garage. (site built? )Deck: (site built?_)
O 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. Co _Existing Well New Well(#of dwellings 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(5003 of tract listed above?( )yes (_)no
Does the property co/Itemany easements whether underground or overhead( )yes ( )no
Structures(existing aroposod): ingle family dwellings.� �nufadured Homes Other(specify):
Required Residential)Property Line Sethacks:L Comments:
Front Minimum DR, Actual �C#aft-
Closest
���hIn////����1r
Rear a—S-- ar�
Closest Side 10
Sidestreeucorner lot
Nearest Building
on same lot
It frnial lead U [ Appli..,t ..n
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINOTON: L\ es ti•
0LQP Cb( 10 YYst 1 .1.n N a cilC c/
If permits are granted l ag •nform to all ordm s an tate of Nath Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoi • • ments are secure and cor of my knowledge. Permit subj t re tion If false information is provided.
-Signature of Owner ner's Amen Date
"'h 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 issued"
R CnLailan( List Aline.i`—u ..i i .
I
•
c s' P ' n i
' w�
'T' •{ j
7 PI AN �Pg7'51'
, g0
36' F / i4f Hl›....). pro �\ 4
D
-,. _. / / c;'02 e co
t.
rn
frP7 , j' V , v2
Z'/ V 0ti S .o
i r g e ti 51ca
rx \fia w
S a
\ �\ u / • A
•
VV\
\Ir
I'
II \ \
1 i \ P \
1 1 \ 4 \
I � N.
tcl+ N.
5 7 N. Rp N
1 7 '\ oo
1 ; N. (SN
1 N. '\
-0 \ /3j \
SITE PLAN APPROVAL N
\ N.
\, o o`
nisiC24\ -LIM
Ric.A __,__ IJSE.. N. \J
N. �\
x6EDR00MS __
q I-�P�- N.
Joffe Zon,ng h w ramr
NAME:N--tf(n tay �i/-�' /-S
APPLICATION N:_
*This application lobe fled out when applying for a septic system inspection.*
Count Heal h Det artment A. .lication for fm•rovement 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 SHALT.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
Environmental Health New Septic SYsfemCode 800 CONFIRMATION#
• Allrooart 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 atlfor 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 sategrguh_ to allow the soil
• evaluation to be performed. Inspectors should be able to walk freely around site. Do not grade property.
All I•is to be :• • :ssed within I s business de s a/er confirm:lion. 2..00 return trig l:,
for l,liu - • unc•v-rou letildm-rk house corners en• •ro• - lin.- - m: ' ,, e . red
• After preparing proposed site call the voice permitting system at 910-893-7525 option lot
schedule and use code
800 (after selecting notification permit if multiple permits exist) for Environmental Health inspection. Pleas note
confirmation number riven ,t end of recording for .roof of re•ue t.
• Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
€nvironmemel Health Existing TankIn ti 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 Ill 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 & select notification permit
if multiple permits, then use code 800 for Environmental Health inspection. Please note confirmation number
cLiven at end ole or in for roof of re u
• Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting
T ir for remaining permits.
If applying for authorization to construct please indicate desired system type's): can he ranked in order of preference.must choose one.
I—) Accepted 1 l Innovative
(�Cunvcmional (.—I Any
I—I Alternative Ll Other _
The applicant shall notify the kraal 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_I YES Iii NO Does the site contain any Jurisdictional Wetlands?
I—)YES (fit/NO Do you plan m hake an irrigating system now or in the future?
1—I YES Iej NO Does or will the building contain any drains?Please explain. _
I IYF.S i N/O Are there any existing wells,springs, waterlines or Wastewater Systems on this property'?
(_)YES /INTO Is any wastewater going to he generated on the site other than domestic sewage?
I IY " L )O Is the site subject toe approval yang other Public Agency?
I— YES f_11',,‘,76 Are there any Easements or Right of Ways on this property?
1_I YES II NO Does the site contain any existing water,cable. photic or underground electric lines?
If yes please call No Cuts at 800-632-4949 to locate the lines. This is a free sen ice.
I Have Read This Application And Certify That TThe Information Provided Herein Is True,Complete And Correct. Authorized County And
State Official re Granted Right Of Entry Tn Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I Understa d'1'hat I Am Solely , slide For The Proper Identification And labeling Of All Property Lines And Corners And Making
The te A c Bible So That els Sit
�atinfi Can Be Performed.
�RS e' I1
PR TI OWNERS • • OWNER. GALR I RESENTATIVE SIGNATURE(REQUIRED) DATE
10/10