DOCUMENTS Initial Application Date. /"/d- 7 Application# !n 5)C)4-au fxs T
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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.hamettorg/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)8 SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER: /Awl* ((,.prig/ (7-/-x'---y Mailing Address:
City: {'�///, State: Zip: Contact No: Email:
APPLICANT': /L1D55 ifi. Lu(Ies5 Mailing�/Address: � k 577
City: Gt/7/7 t !!FF'' State!L zip.275V4 Contact No: &rt. C'2//7 Email: ?524 Ada SS Gx jA.(a;/ro.�
•Please fill ON applicant information a different than landowner J
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CONTACT NAME APPLYING IN OFFICE:/' J Phone# z/ �J
PROPERTY LOCATION:TQSubdivision': ( C2,, IZ e'I/4 ' 1i) //' / L Lot#: 7 Lot Size: ' 577 ,4 'e S
Slate Road ft I J bq f,State Road Name: j O{/ /yp.,./ CNT Ol' :�//L - Map Book Pageg �I /I -' S 3
parcel:% i'• U.DI b UaSS 6 1! PIN:Cin ryejt tO "l.3 q{Cl ,3 ,L' bW
pp /X Watershed—Ct. Deed Book 8 Page. 32.4.b/ QS Power Company: )let- £neer y
Zoningrylood Zone
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Z. S/ ., 2 ,1 Menatimi=
SFD:(Size LI?1�x 55)#Bedrooms'.#Baths5Baa�ement(w/wo bath)/!L Garage:..Dec /Crawl Space:_Slab': Slab:_
(Is the bonus room finished?(✓)yes ( )no w/a closet?(_)yes ( no(if yes add in with#bedrooms)
❑ Mod:(Size_x_)#Bedrooms #Baths_Basement(wlwo bath)_Garage._Site Built Deck:_ On Frame_OR 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:(See 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. County Existing Well New Well(#of dwellings using well )'Must have operable water before final
Sewage Supply: V 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 eel(500')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: n(yr 4 X� tranCffaac(�tuurred Homes: a� Other(specify):
Required Residential Property Line Setbacks: / Comments: C`•+ s O i'cEI
Front Minimum ?55 Actual tliO
Rear 25 /02—
Closest
U`Closest Side //i) 50
Sideseeet/corner lot //"//�
Nearest Building /'in
on same lot 03Ii 1
Residential Land Use Application Page 1 of 2
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGT N: 112. i AiJ Ge% on 6014 (C eo—i
'5 A4;1 es . r/a f.t-1 tce£ /Pd F c.1 Joe( wC. / Z"d /of on 434°
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 statements re accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
/Z Sn/7
Signature of Owner or Owner's Agent Date
"'It is the owner/applicants responsibility to provide the county with any applicable Information about the subject property,Inclus:gnu but not limited
to:boundary information,house location,underground or overhead easements,etc.The countybr 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"
Residential Land Use Application Page 2 of 2 03/11
SITE PLAN APPROVAL
Zed DISTRICT I2P1,p USE
57-/ Acre= •BEDROOMS 3
fir'. ./ar QC° If CCD
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NUR iH UAHULINA HARNETT COUNTY
Mickey R Bennett.PLS do certify that MR plat was drawn under
DEED REFERENCE my supemtlonldeed description recorded in Book SEE
DEED BOOK 3292,PAGE 894 Page illikalbat the boundaries not surveyed are clearly
indicated as drawn from information found in Book .Page SEE REF.
MAP REFERENCE that the ratio of precision as calculated is I:1000031at this plat
MAP NO. 2015-94 was prepared in accordance with G.S.47-30 as amended.Witness
my original signalure,registratfon number and seal this
day of
�a CAROL
Q, OF ESSION�9 MICKEY R.BENNETT
4 �� L-1514
WSEAL m
No. 1514 LuwxEYRaENNEr.po HERESY CERTIFY
P THAT THIS SURVEY CP TES A SUBDIVISION
OF56036'5rE n Tib 1G JNLAPALRY THAT HAS AN ORDINANCEETTHAT
'f' SURJE REGULATES PARCELS Of LAND
126.72' $4.. R. B
187.00'
68.00- a EIP
7. 0.574 AC. ir
0.575 AC. a
$ - N '8 z.
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122.50' 35.00' w-k
5.0 0.575 AC.
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so ruouc AND UTILITY CASEMENT 4,
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(TOTAL)
71.0T 156.53' 0`' 146.58'
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N 6832'03•W 26.0T
NAME: nil.0%.&C. \- rwnP 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)
910-893-7525 option 1 CONFIRMATION#
Environmental Health New Septic SvstemCode 800
• All property irons must be made visible. Place "pink properly 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 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 tee 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 recordinu for proof of request.
• Use Click2Gov or IVR to verity results. Once approved, proceed to Central Permitting for permits.
Environmental 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 Ild 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 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 to construct please indicate desired )ystem typets): can be ranked in order of preference,must choose one.
14./(Accepted I—I Innovative l_ Conventional (_) Any
{-1 Alternative ( Other' e>
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�
) /11441
The applicant 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:
I-1YES I/i ^'O Does the site contain any Jurisdictional Wetlands'.'
(_IYES {.4NO Do you plan to have an i[ ation=ysLm now or in the future?
IIYES I 'NO Does or will the building contain any drains?Please explain.
1 )YES I ��/O Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
)YES (.410 Is any wastewater going to be generated on the site other than domestic sewage?
I-1YES {,‘NC) '?
Is the site subject to approval by any other Public Agency
{_}YES LLI!t 10 Are there any Easements or Right of Ways on this property?
{_(YES I_3 O 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 This 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 Accessible o That A Complete Site Evaluation Can Be Performed.
/072517
PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) AT
10/10
HARNETT COUNTY CASH RECEIPTS
*** CUSTOMER RECEIPT ***
Oper: 'BROCK Type: CP Drawer: 1
Date: 18/26/17 52 Receipt no: 129898
Year Number Amount
2817 58842628
91749 TECH 2
LILLIHGTON, NC 27546
84 BP - ENV HEALTH FEES
NEW TANK $750.86
MOSS HOMEBUILDERS
Tender detail
CP CREDIT CARD $758.08
Total tendered $758.88
Total payment $758.00
Trans date: 18/26/17 Time: 10:85:33
** THANK YOU FOR YOUR PAYMENT **