LAND USE R Initial Application Date.. —r (
" x^�p CO' Application k 1%7 56 gas-nag✓ V
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NTY 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.harnett.ore/permits
P# "A RECORDED SURVEY MAP RECORDED WHEN SUBMITTING A LAN
TO PURCHASE)&S DEED(OR OFFERLAN ARE REQUIREDD USE AATION"
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LANDOWNER'. y SA ring r/ 4-(.1.4/j/LL ailing Address: Zj Z
City. iein.44,.../ / StaW Zip4S343ontact No a/Ow 2 7'.OV mail: 3' p)pa 0.1.54,5 /076744
APPLICANT*:rile 9 emit�' �p,5emael nggAAddress': PO /Soy £4' cJ i
City ,AritIon statejlt Zip ontact No: Q/!N2 2�do.A/
'Please fill out applicant information ifdifferent than landowner
mail. �r^.� �a'LJ
CONTACT NAME APPLYING IN OFFICE: SAS,AA C tp9en Phone q) a.z(scT pq
PROPERTY LOCATION:TISubdivision: i 32 S Iio,:. ed.
Lot ft (- Lot Size' I 2.
State Road# I In C State Road Name: L..bp ed. 2 J�eMap+B000k&&rPage':9011 1- D
Parcel' qq��0I05M _` PIN'. I J / ' `7J 482s-cab
Zoningg 'WQ Flood Zone: [N WatershedA/D Deed Book&Pag_, i-f rower Company':
'New structures with Progress Energy as service provider need to supply premise number 1 from Progress Energy.
PROPOSED USE: 3
SF(/'(Size}//''�._ #Bedroom's]! #Baths Slab1__
U SF .
x ) L Elasement(w/coo bath):_Garage f( Deck. Crawl Space Slab. Slab.
._ o ._
(Is the bonus room finished?,J yes ( )no w/a closet?k5J yes (_)no(if yes add in with#bedrooms)
lib,l Mod.(Size x_)#Bedrooms #Baths Basement(w/wo bath)_Garage: Site Built Deck: On Frame_Off Frame
(Is the second floor finished?( )yes ( )no Any other site built additions?(J yes (_)no
LI Manufactured Home._SW_OW_TW(Size x )#Bedrooms: Garage. (site built?_)Deck: (site built? )
❑ Duplex:(Size )No.Buildings: No.Bedrooms Per Unit.
Q Home Occupation:#Rooms. '1 Use' J JJ.�1t�'�A / Hours of Operation: 1E,�,,,'c'(,,�"�1' #Employees:ye
S. AdditionlAccesso Other:(Size 37 x qQ )Use:Qycitlil A / 1k� 'ygo nl S I Closets in addition?(.V/)yes ( )no
Water Supply _County .Existing Well _ Kew Well(#of dwellings using well )'Must have operable water before final
Sewage Supply: New Septic Tank(Complete Checklist) Existing Septic Tank omelets Checklist) County Sewer
Does owner of this tract of and,own land that contains a manufactured home within five hundred feet(5001 of tract listed above?(_)yes (4 no
Does the properly contain any easements whether underground or overhead( )yes (x)no
Structures(existing or proposed):Single family dwellings: Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: x Comments: // a /r.
Front Minimum 35 Actual IG % kpa1 I- —1Z.L JISL'M hi n
Rear Zs 0 II () 11/1•44.--
Closest
IMSA--Closest Side ID WO 1
.-SldestreeVcorner lot
Nearest Building IID
on same lot
Residential Land Use Applicalion Page 1 of 2 03111
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
J
If permits are granted I agree to conform to al • •inances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing statements rate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
_ r sJGtory
Signature of e r or Owner's Agent Date
***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,hou$e 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••
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Residential Land Use Application Page 2 of 2 03/11
NAME:
APPLICATION a: (-1)-51‘
*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 ex{ration
depending upon documentation submitted. (Complete site plan=60 months;Complete plat=without expiration) LILO
9t0-893-7525 option I CONFIRMATION# b r
❑ Environmental Health New Septic SvstemCode 800 _ L a to I• Pi
• All properly 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 atttor Central Permitting.
• Place orange Environmental Health card in location that is easily viewed from road to assist in locating properly.
• 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 lidmark 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.
JY 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 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
even . end of rec•rdin• for •r•ef of re•uest.
• Use • ick2Gov or IVR to hear results. Once approved, proceed to Central Permitting for remaining permits.
1. S PT C
�+ If applying for auth ization to construct please indicate desire . stem type(s): can be ranked in order of preference,must choose one.
(_I Accepted I_I Innovative I Conventional
1J Any
I—I Alternative I Other
The applicant shall notify the sal health depar lent upon submittal of this application if any of the following apply to the property in
question. If the answer is"yes", ..plicant 'ST ATTACH SUPPORTING DOCUMENTATION:
(_)YES I—I NO Does the st - • ntain any Jurisdictional Wetlands?
I—IYES II NO Do you pl. t have an irrigation cvstem now or in the future?
IJYES (_I NO Does or • ill the . ilding contain any drains?Please explain.
I_IYES I I NO Are t.-re any exist' wells,springs,waterlines or Wastewater Systems on this properly?
I_I YES i_I NO Is• y wastewater goi t to be generated on the site other than domestic sewage?
I—IYES I ) NO the site subject to appro 1 by any other Public Agency?
i—IYES I_I NO Are there any Easements or Rt_ t of Ways on this property?
IIYES i_I NO Does the site contain any existing ..ter,cable, phone or underground electric lines?
If yes please call No Cuts at 1300-632-4949 to locate the lines. This is a free service.
I Have Read This pplicatlon 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 AmSolelyResponsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site cess .le
,op A Complete Site Evaluation Can Be Performed.
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P OWN a:r�OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) Ix) DATE
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