DOCUMENTS 14
Initial Application Date. It'ra.3) I [ Application# I' 1aJC "^(O W
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext.2 Fax:(910)893-2793 www.hamett mg/permits
^A t/151•443
RECORDED SURVEY MAP,
RECORDED DEED(OR OFFER TO PURCHASE)8 SITE PLAN ARE REQUIRED WHEN SUBMITTING� A/LAAND USE APPLICATION"
LANDOWNER: 1._1 j\ E
,j IS 4
Mailing Address: o Vi` N (40-1
City: h 11,-10,,,, Staler`^-,�1/Zip:wZ�V4ontact No: y_,/ Email:
APPLICANT/':, #1655 4c7 avos4LL ? /`1 la ng Address: f(� `y'Y `�77 �Y
City: /_144--r NWIW State:Al- Zip:/Th4b Contact No:(ID O) �D -2/03 Email: (<w/11asysr tiAzerrl,u/E7
'Please fill out applicant information if different than landownernd ,alp' �Q I � y,
CONTACT NAME APPLYING IN OFFICE: k Al I `ate Phone ft 1 i b-2/(15 V (�
PROPERTY LOCATION:1Subdivision' / ,t C l Lot#: LototSize:iz • 7r�x1L
State Road I-US l (State
Road�adName. Old L L5 (4>1 I-�/ Map Book 8 Pa9ayy+a✓/ I( el
Parcel:Q1�1) 0( ' �i0 0)41 en PIN: CWCT'D - YIU/-IC/Pkarl.1.
ZoningQ Flood Zone: �. Watershed[ Deed Book 8 Page: 'WO / 3,T Power Company:
`New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Size x )ti Bedrooms: a Baths: Basement(wlwo bath)._Garage:_Deck: Crawl Space: Slab:_Slab:
(Is the bonus room finished?(_)yes ( )no wl a closet?(_)yes ( )no(if yes add in with#bedrooms)
❑ Mod:(Size x )ti 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 )t)Bedrooms: Garage. (site built?_)Deck: (site built?_)
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
• Home
Home Occupation.#Rooms: ..����11 '¢{/.�� Use: /� Hours of Operation: #Employees:_
µ Addition/Accessory/Other.(Size sfa x`Zs)Use: �� CTCJ4� Closets in addition?( )yes (_)no
L 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(500)of tract listed above?( )yes ( )no
Does the properly contain any easements whether underground or overhead( )yes (_)noov
Structures(existing or proposed):Single family dwellings 14_ 1 Manufactured Homes: Other(specify):
513 O#sC' eti-r'er--
Required Residential Property Line
Setbacks: Comm
ents:
Front Minimum SS Actual
tb (5-
Rearr;S _d7- V
(R-ttt g,(4-5-b --
Closest
C -5-b --Closest
Side u I
Sidestreet'corner lot
Nearest Building I b ILD
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
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•
If permits are granted I agree to conform to all ordinances and laws of the Slate of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing statem are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
to-2 /7
/14Signature of Owner or Owner's Agent Date
•
"It is the Owner/applicants responsibility to provide thekounty with any applicable Information about the subject property,includinglut not limited
to:boundary information,house location,underground or overhead easements,etc.The county or its emplOyoes are not responsible for aoy
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"
•
Residential Land Use Application Page 2 of 2 03/11
SITE PLAN APPROVAL - --- /
DISTRICT4\Sly USE SSS °---
*BEDROOMS
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NAME: ink—u—"5 "'-^ •�-B - S APPLICATION#:
*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)
CONF1RMATiON#
910-893-7525 option I
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 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.• If property is thickly wooded, Environmental Health requires that you clean out the underarowth 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 recordina for oroof of request.
• Use Click2Gov or IVR to verity results. Once approved, proceed to Central Permitting for permits.
Environmental Health Existina Tank Inspections Code 800
Y • 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 & 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.
SEPTIC
If app lying for authorization to construct please indicate desired system typetsl, can be ranked in order of preference,must choose one.
II Accepted I-1 Innovative I-1 Conventional I—i Any
1-1 Alternative I— Ether Ai
The .plicant shall notify the ocal health .epartment upon submittal of thi'applanon if any of the following apply to the property in
quest n. If the answer is".es",applicant UST ATTACH SUPPOR t NG D I CUMENTATION:
I—I ES I-1 NO Does the site co ain any Jurisdictional We ands'!
1_1 ES 1J NO Do you plan to h'ye an irrjationsylem .w or in the f ure?
11 ES 1—I N00 Does or will the b ilding contain any ars is?Please expl' . — —
I—I ES f-1
o Are there any exis 'rig wells,springs.w.terlines or Wastew•ter Systems on this property?
1-1 ES I NO Is any wastewater +ping to be generat-v on the site other tha domestic sewage?
II ES I NO Is the site subject u approval by any 'ther Public Agency?
1_) ES 1 I NO Are there any Ease -nts or Right of ays on this property
1-1 ES I I NO Does the site contain ny existing ater,cable,phone or undergrou r electric lines?
If yes please call No is at 800-.32-4949 to locate the lines. This is . free service.
I Have 'ead his Application And Certify That The In • • on Provided Herein Is True,Complete And '• a • I horized County And
State 0 ci Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I Unders nd That I Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site Accessible o That Ao Complete Site Evaluation Can Be Performed. /O-23- ( 7
OPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10