DOCUMENTS Initial Application Date: 051h7 Appliratbns I 1sai_ca--59
Cu,
COUNTY OF HARNETT RESIDENTIAL LAND USE APPUCATION
Central Permitting 108 E.Front Street.LSlington,NC 27548 Phone:(910)893-7525 ext2 Fat 1910)803-2793 www hametl.orypenNls
^A RECORDED SURVEY NAP,,RECORDED DEED(OR OFFER TO PURCHASE)d SITE RAN ARE RECURS)IIWH''EN SUBMITTINGAALAND USE ANIMATION"
LANDOWNER: lZCkMtc( ►�IcAridly Mating Address: 94 tufa F�Yxrd
City: BVnAk-gti (T--�� �'�' (' `statle:J C zip:28315Contact No: 7L*{'2OZ-112-Ethan: •v/i
APPLICANT':Soda. GVe 9 SDIJ'I1nx's Mailing Address. �y3f SP/rnq 51 L-
City: Lim i(�o.\ Slate:tui- Zip.9i✓N Contact No: 7ix/'2cZ3tl2 Email: k�s1 Leif;scu fctenni 5�141c4Sb.
'PYesanil M applicant information n d eenl than laMoner /) 1
CONTACT NAME APPLYING IN OFFICE: NIS Phone
PROPERTY LOCATION:Subdivision: 5(aie CS 4.40tt _Lott I L.ot Sizze::q' .q3 AL
State Road N t `Z\\I State Road Name: LA�Lr0 R 4 ��rr ,,�� Map Book&
PagC3'.'rt\/ a
Parcel: ! a CY (o Lc C)l PIN._OySII- ULA)' � — �'t) (XM
Zonino 49 Zeno( .Watershed:kbeed Book&PagetS.0O/ ("(Power Company' DUr'k'
'New stmdures with Progress Energy as service provider need to supply premise number from Progress Energy-
PROPOSED USE
Monolithic
❑ SED:(Size_x )N Bedrooms._I Baths:_Basemenl(w/wo bath):_Garage:_Deck:_Crawl Space: Slab:_Slab._
(Is the bonus mom finished?( l yes L)no w/a closet?(J yes U no(If yes add in with N bedrooms)
O Mod:(Sae x )Y Bedrooms *Baths Basement(whim bath)_Garage:_Site Built Deck:_ On Frame_Off Frame_
(Is the second floor finished?( 1 yes ( I no My other site built additions?I 1 yes ( I no
❑ Manufactured Home: SW DW TW(Size x )N Bedrooms'_Garage: (site built? )Deck: (site built? )
❑ Oupler(Sae x )No.Buildings:_. No.Bedrooms Per Unit:
❑ Home Occupation It Rooms: Use'. _ Hours/ of "
OpOpera/kwI/Employees:_
U AAddition/Accessory/Other(Size_x_)Usee )Wf.21—Y_ r eki - "/ S Closets In addition?LJ yes ( 1 no
Water Supply _County /besting Well New Well(U of dwellings using well •Mist hays operable water before final
Sewage supplplic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) County Sewer
Does ovmer of this tract of land.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 overhead U yes U no
Structures(existing or proposed):Single family dwellings: Manufactured Hones: Other(speofy):
Required Residential Property).ins Setbacks: Comments: GZO I b^k ( J(,
Front Minimum Actual
Rear
Closest Side I
SideslreeVcomer lot Ott N�za
Nearest Building // a61
on same Id
Residential rain Usc:AVrM1cilum n'igt I of
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILUNGTON:
1
If permits are granted I agree to conform to all ordinances aritl,jws of me Slate of North Carolina regulating such work and the specRtabons of plans submitted.
I hereby Mate gal foregoing Materna - - -• rate and co to the best of my knowledge. Pent*su - to re bon If false formation is provided.
q 2.c /7
• mor�• nal Award Dab
"'It is t1 ownerlaPWNant reepomibllity to provide the county with any applicable Information about the subject property,Including but not Ilndted
to:boundary Information,house location.underground or overhead easements,etc The county or its employees are not responsible for any
Incorrect or miming Information that is contained within these applications."
"This application expires 6 months from the Initial data If permits have not been Issuer
rrs.ueceel l and in, nfmn::a...,, 'oro•-2.J2 u3
HTE# Kr-5:5(11Q, Harnett County Department of Public Health 2 4 2 8 6
PERMIT # OD.—.) _ Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 41b W in*.
Name: (owner) D.se-\x cYRp n r,4.r.,,w G2 SUBDIVISION — LOT #
System Installer. KC.+rve\H Registration #
N
Basement with plumbing: ❑ Garage"tel Number of Bedrooms
Type of Water Supply: LI Community ..i< Public ❑ Well Distance from well leer
System Type: _. . _ -- —. _ Types Y and VI Systems expire in S yean.
(In accordance with Table V al Owner must contact Health Department 6 months prior to expiration for permit renewal_
This aye ECM mr ben metalled in comphanre nth apphobk North Laminin General Siarthea.Amer for Snap TrMrmem and Dural and all nondwom of the Improcemenl Perm and Connrummn Authorization.
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N O rIE
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961.Other _
Subsurface system operator required? Yes ❑ NX
II yes. see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation
V. Other:
D-Box ❑ Pump ❑ Alarm ❑ H2OLine C:i PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
type of system: ❑ Conventional X Other E-Z f a_w_ __._ Septic Tank: L 60 V gallons Pump Tank: gallons
Subsurface — of exact length width of depth of
Drainage Field ditches lZy of each ditch _5 O— feet ditches 3 feet ditches 1z _ inches
french Dram Required. rear feet
[Authorized State Agent Date 10)4)16
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Application*
Harnett County Central Permitting
PO Box 65 Lillington,NC 27546 - Ph:910-693-7525 - Fr 910-893-2793 - www.hamett.orglpermits
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner(s)of Structure: RICAm-PI mc/r/51c,c Phone: 705 '263 —St K
Owner(s) Mailing Address: I'e W/RE nes
vno/such NC a&32-3
Land Owner Name(s): Stele As e9-40 vE Phone:
Construction or Site Address:
PIN* Parcel#Stint-.M-�^^ L.
Job Cost: gi 000 Description of Work to be done SL/eS/$7//q/rk4
Mechanical: New Unit Wnh Ductwork_ New Unit Without Ductwork_ Gas Piping_Other_f
Electrical': 200 Amp_<200 Amp_Service Change_ Service Reconnect_ Other kr/-S6/QR
•For Progress Energy customers we need the premise number
Plumbing: Water/Sewer Tap Number of Baths Water Heater
Specific Directions to Job from Lillinoton.
Subdivision: A'/4- L Lot#: N`�
t�E/✓ ��N//OR will provide the 4E�e�7„cA"I labor on this structure,
(Contract s Name) (Trade)
I am the building owner or my NC state license number is 3 09 70 — ,,which entitles me to
perform such work on the above structure legally. All work shall comply with the State Building Code and all
other applicable State and local laws,ordinances/ and regulations.
�ovy
yrce Ger UDt///Iev. .lviC. W 2o2--S7J;Z
Contractor's Company Name Tel
513
-5
416 1 /�Aelien NC' akd36 h"noire
S44rotS. u"t
Address Emai Address
3v9.7o - u
License I
Structure Owner/Contractor Signatures Date: /23/,
By signing this application you -'ou have obtained y nnission from the above listed license holder to
purchase permits on their beha . f doing the work as owner you understand that you cannot rent,lease or sell
the listed properly for 12 months after completion of the listed work.
'Company name, address, &phone must match information on license