DOCUMENTS Initial Application Date: 1 of '/ I • 1 Application I •SO D La 1 qr
Cuts
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillinglon,NC 27546 Phone.(910)893-7525 ext:2 Fax:(910)893-2793 www.harnett org/permits
"A RECORDED� SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)8 SITE PLAN ARE
REQUIRED' .fWHEN
SUBMITTINGTI_A LANDfUSE APPLICATION**
LANDOWNER: MCIVI„ LCX Mailing Address: 60R I Ib ICI tor P.01-FA
city. i-Illk N4stGrt State: NC Zip:xis*Contact No: en 0-S1I-062- Email: Mcuc VOLI Q-i is I.ccwl
APPLICANT': Mailing Address:
City_ State: Zip: Contact No: Email:
'Please Oil out applicant Information if different than landowner
CONTACT NAME APPLYING IN OFFICE: 2� ,[it^. .�,/ s� Phone /
PROPERTY LOCATION:Subdivision: �-Q,Vk.' II /24 Js� kt r C CCN Lot#:3A Lot
Size:S, h 6le
State Road# 1x53 State Road Name:/� H OIZ1Yt 1 eIck Map Book 8 Page:O 0I 7/ /77
Parcel. 13 b52,9 O04alog_PIN: D5IR- id -33XX•O�
Zoning:RAZDFlood Zone. )0 Watershed:Psv Deed Book 8 Pager S 13 Wallower Company':
'New structures with Progress Energy as service provider need to supply premise number from rogress Energy.
PROPOSED� USE:S �/ Monolithic
� ) SFD:(Size 6 ,51 -)#1Bedrooms,3 #Baths.. Basement(wlwo bath): Garage X Deck:_ v wl Space:/ Slab:_Slab:_
l `• (Is the bonus room finished?(_)yes (X)no wl a closet?(_)yes (X)no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms_#Baths Basement(wlwo 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 x )#Bedrooms:_Garage. (site built?_)Deck: (site built?_)
❑ Duplex:(Size_x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms. Use. Hours of Operation: #Employees:
U Addition/Accessory/Other:(Size_ _)Use: Closets in addition?( )yes ( )no
Water Supply x County Existing Well New Well(#of dwellings using well )'Must have operable water before final
Sewage Supply: p 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
Does the property contain .I - semens whether underground or overhead(_)yes (_)no
Structures(existing 0 Ingle family dwellings. , Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum Actual 11.0
Rear ILIA
/A
Closest Side L4
Sidestreet/wrner lot
Nearest Building
on same lot p31t t
Residential Land Use Application Page 1 of 2
APPLICATION CONTINUES ON BACK
SPEm FIC DIRECTIONS TO THE PROPERTY FROMLILLINGTON: InletIVC
on - µ7 4 miles to Holder
Road, TM.A ri t oA 1-u I-jokier � t
a. IA . 6 nine arn iA tint
14 drivevui nCr 602. Cditettl y acov.s f'ronrk 585 Fteldrr Read). bi-;vc
to -frke ba of 4ht yard t) a (atTe rink ditck. T.rA rib}.t IU
collo..) tkv dt-k. Cross +h.. ditch l if A tiA(.1) a- : -Eke- encl' o F -€let
cfrld. when ( C'( tro4c tine ditc1t ) yo‘A, are OA the St' .
If permits are granted I agree to 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 statemen are accurate rrec the best of my knowledge. Permit subject to revocation if false information is provided.
%C 10/6/17
Signature of Owner or Owner's Agent u • pate
•
"'It 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 ibformatlon that is contained within these applications.**'
"This application expires 6 months from the initial date If permits have not been issued"
Rosidenttal Land Use Application Page 2 of 2 03/11
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NAME: CO(A IVI'ei I/1 \ ,\r APPLICATION it:
*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#
X Environmental Health New Septic Svsgg Code 800
• All property Irons must be made visible. Place "pink property flags" on each corner iron of lot. All properly
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 aVfor 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.125.00 return trio fee may be incuneq
for failure to uncover outlet lid.mark house comers and property lines.etc.once lot confined 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 oroof of reguest.
• Use Click2Gov or IVR to verity results. Once approved, proceed to Central Permitting for permits. •
❑ fnvironmental Health Existing 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 recording for proof of reouest.
• Use Click2Gov or IVR to hear results.Once approved,proceed to Central Permitting for remaining permits.
SEFFIC
If applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference,must choose one.
I_{ Accepted Li Innovative LK)Conventional 1-1 Any
(-1 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. Ifthe answer is"yes",applicant MUST ATTACH SUPPORTING DOCUMENTATION:
l_IYES (X) NO Does the site contain any Jurisdictional Wedands?
{_1YES {:,k) NO Do you plan to have an Rita:don system now or in the future?
(_1YFS Oil NO Does or will the building contain any drains?Please explain.
IYES I x 1 NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
I_IYES IX)NO Is any wastewater going to be generated on the site other than domestic sewage?
1_IYES 11 NO Is the site subject to approval by any other Public Agency?
1IYE5 {_I NO Are there any Easements or Right of Ways on this property?
{_IVES {X}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 Thh 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 A •eS.TAagA Cone S Evaluation Can Be Performed.
/L C 10/6/I?
PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10