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Initial Application Dale. 1 C)] 4 1 Application# 17 SDo(-1-04 8-9 cult COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION Central Permitting 108 E.Front Street,Lillinglon,NC 27546 Phone:(910)893-7525 ext2 Fax:(910)893-2793 www.hamett.orglpermlts "A RECORDED SURVEYMAP,RECORDED DEED(OR OFFER TO PURCHASE)£SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION" LANDOWNER: Zarymigha \ O- O.AAJ b( Mailing Address: PD. GVQk SOL City. CI IUlf-USA-On t,zip:a7.S4frnntact No:910-fiia,4 -(nSU Email; ; Lb.& APPUCANT': "Sea a, 4S ablA/N Mailing Address: L3 City: Slate._Zip Contact No: Email: 'Reese Ml out spoken'information If different than landowner CONTACT NAME APPLYING IN OFFICE: Phone# 1 ,, ❑ PROPERTY LOCATION:Subdivision. I 1 Lot#. L Lot Size: � C +C. State Road# Yr�C% �7 State Road Name: 1S `i a I l� I / I Map Book&PPaaggeeF,7. l 7l 1 - Parcel:P/�/w�.1. ,.rtl-l}a�.( t�iK`Y 1/ PIN. /34. C) - `Y�D;egg.? `^ V Zoning J� 36 Flood Zone: " Watershed' `N o-IV Deed Book 8 Pap( ) / 1 )_Power Company. -New structures with Progress Energy as service provider need to supply premise number from Progress Energy. PROPOSED USE: 3.5 / / Monolithic Li SFE'(Size 10D x_s�_)#Bedrooms-*#Baths: Basement(wlwo bath): Gazage': J Deck: ✓ Crawl Space'_Slab: Slab. Os the bonus room finished?( yes ( )no w/a closet? )yes (—)no(if yes add in with#bedrooms) LI Mod.(Size r )#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 LI Manufactured Home: SW_DW TW(Size )#Bedrooms- Garage. (site built?_)Deck (site built_) ❑ Duplex.(Size x )No.Buildings No.Bedrooms Per Unit. ❑ Home Occupation#Rooms Use. Hours of Operation: #Emptoyees: ❑ AddhttonlAccessssory/Other(Size x )Use: Closets In addition?(_)yes (_)no Water Supply. ✓ County 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(5D0')of tract listed above?(_)yes ( no Does the property contain any easements whether underground or overhead(✓)yes (_)no Structures(existing or proposed).Single family dwellings. I _ Manufactured Homes. Other(specify) Required Residential Property Line Setbacks: Comments: Front Minimum 13') Actualet S- aitRear Closest Side SidestreeUrvrner lot Nearest Building on same lot liesmnnlial I and Ilse Ni l,L lion I'anr+ I of/ 03!11 APPLICATION CONTINUES ON BACK SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: 1O%CC WS oL1 4•I/ a has c rte \ t% ..C�1 r .,, -'-- r; 4` is 'r Rore_ >`tcll li • II 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 foreg• g statements are accurate and correct to the best of my knowledge. Permit subject to revocation�� it false Information Is provided. 2 it / ff S .nature of Owner or Owner's Agent Date "Ht is the ownerlappllcants 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" Kondlorual L and Use Apoliomoo Page 2 of. Off/11 • o O s o !I C, } _ m d9 -a m- Di I i ' £ A I 12 I I N33 II N I > I 1 0 \ 1^ In 3 r U to z Jo I1 ,� 0 r oea mr ^ 3ma w u1 I a �� ° ° `_ - _ 9. p m B � 02 I x. I c Z 1 0- (101°1,00'0£Z) M.,9l�L£o£o N N v I m LO _OQOlZ_ _ '• z o` Imo-,• oo•otl - - - - - --yew .m a•p°o oasoaQ,"d _ Ir _ m o o Ici 0 II o N •�- N 'A I -O••SL • N 0 IOm < 1 O ..SSS n 10 Na I ( a o• •-o• , o'z .� m 0 U ^so•.-1 2 UI la I' a o IG a (O m ccoo�a o-s mI �e• I Im n D © 4:2A.° d.. o L I CA O Im m' II _ n 1 I m o 7 •03 m p rn N I m I I s3 I I an .m y u - - - ,00'0lZ CO 1 2 oo'oZ (101°1 ,00.0£Z) 3•.90.L£=£0 S l0 2 1 I I 1 I m 9 s `° 14t= $ 1 I u 1,40 I -40 CO N I qv� II I I (CO� fi III �, r +' I 0cx c -. �0 na 0 I`° 1 SEu�m� °o$ Ir1 ° -pia 0 0 on3,�2 _ Lwn m 133 &To m3 A o II 3 v, ^3 .... 3 E- o .m° 1 a I I I NC GRID NORTH 0 A- �Q. - r r. 1 I C (13 m NAD 83 (2001) m p -1 InC C-. o. _ n H o v N m e00D ril. ^ o 0 -. o Qp -13 OZQ o - o. 0 II AR O Non , o r I cn (f) H to z E O- n c -� O o33 a ' 0 -- v � C � a 0 0 o °o i n UI r NAME: �Opp 4„ 1_ s_. . . APPLICATION I: *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 TI IIS APPLICATION IS FALSIFIED,CHANGED,OR THD,SITE IS ALTERED,THEN THE IMPROVEMENT PERMIT OR Al ITHORILATH)NTI)CON STRIICT SHALL BECOME INVALID. The permit is valid for either(ill months or without expiration depending upon documentation submitted. (Complete she plan=MI months;Complete plat=without expiration) 910-893-7525 option I CONFIRMATIONS — - 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(lags"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 recording for proof of request. • Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits. €nvlronmental Health Existina Tank lnsOectlons Code 800 • Follow above instructions for placing flags and card on properly. • Prepare for inspection by removing soil over outlet end of tank as diagram indicates, and lift lid straight up (if possible) and then put Ind 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 request. • Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting for remaining permits. SEPTIC If applying for authorization In construct please indicate desii ed system Iypets I'. eon he ranked in order of preference.must choose one. I—I Accepted I—I Inmos alive I- I Conventional I—I Any I—I Alternative I I Other The applir ant 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 III/NII Does the site contain any Jurisdictional '! d Wetlands I—}YES { O Do you plan to have an irrigation system now or in the future? (_IVES 1Ir'10 Does or will the building contain any drains?Please explain. II YES 1-_ I NO Are there any existing wells, prings. wutelm s Or Wastewater Systems on this property'! I—I YES I_AN(1 Is any wastewater going to be generated on the site other than domestic sewage? I. I YES I_IND Is Ihr site subject to approval by any other Public Agency? 1AYES I- I NO Arc there any Easements or Right of Ways on this property'? YES l all N(1 Does the site contain any existing water.cable,phone oi underground electric lines'? If yes please call No Cuts at NC/0-,32-49a9 to locale the lines. This is a free service. I Mase Rend This Application And Certify Thai 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 Thal I Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making The S Acuasrrklr So That A Complete Site Evaluation Can Be Performed, PR( RTI' ERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE 111/Ill COMA ,.coolant 1 r' Hornell County Iaearanbar r»atom "Control Litt"' I Ma as an rata as raw unto aphnea Y.M...de,.w,, ��IA/w�wtMM Gatos Wane Snnnlet.wem '-'date ata - -- Us Passe -Tate m m pe Ns Cam LiStpmn Into. 4.2A 4ou)art s .San crit or S Mt 1 I ` tter, lfkit GC b Tae. (NNW%. Prop.xkv3 'is DA Alms. (Arrver ei `Sn �pe. tm, a nil 431, 1 tiadnon WM , 1' Lot L 1 Deaaplw*MASS Ata„) Cpn6arruatlan - OatMaoome t 4 : IMMO OFalla._mhaMaa ePFashaa Dain_ Room' '%owl Spa. ✓Jlab wY t"tier: I Meloy owl*Mr I hen the marbly to m.p Hwy alpinabon Me err rppla.jon is caret ' and 0W 01e tonsbuoten sMll 0artam b the reaulolga n Vis Building Elootnial Plumbing and N.dtreesl coda end the Hint Cary Zones Ordinance I .b Pr. otamosen on do eon cenlrewws r coma a known to mac ed Or if nun r enter rp rd—Vudet>Ir1O�SNmIM pat gwpN vr awn1 ashy it Amy responsibility to nobly Ihs Hamm Canty Cows Prang =ni of " rar •0Months b2yews pennereissue bsgIMO 00 Me 2 years*issue fee n!pr rnsr'Ne schedule o_.'\_\y,\dVdI D -6—I I0 IConYeabrlDlfer( Orb 10alCamorebon Theundraped Affidavit0for.WOAaN r'e CampanMs, N C 0$ S7•14 —Goners(Commoa Yoww ___OOr siM sntaOrCoins&Oar Do ha*confirm under periodos of perpry Mr the prsor(s) fent(.)or aoryonlrrq.)pertemwt0 the work is foram Me wind ._He.Ilya(3)or more employees end has iteered workee oompsrneebon insurance to cover Mem Mee one(1)or more euboabsrra(•)end la tamed workers oompsrrean insurance b Dover p (mor more�s)who hes Mew own pokey otwade 0agenabon insure* towirrersMa no mea Men Iwo(2)smpbyea and no eubcc*.c s �l tyle o working on ss pew for watch his pent s sought it is understood that the Cenbsl Pretend e d Dearbrr marc the send mayream ordain of coverage a wakes arnpsneebon eau its pct to aeras olds pro and w any Wee dare the penned work from any parson tun or caparison arra at the work Company orHomo nNrtkdn ` chlor . 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