DOCUMENTS R Initial Application Date: Application# IS
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kk ��1 I COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Fr t Street,Lillinglon,NC 27548 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 WWI thamettorglpermits
"A RECORDED SURVEY MAP,RECORDED DEED OR OFFER TO PURCHASE)8 SITE PLAN ARE REQUIREDs��WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER:, R (WC t (y.-� `�41c,� —�T[/ Mailing Addressm�TJIlt1WJ p1
City: �1A1 �(l0(8(; ,1� State:Al Zip2 , �z�ontad No:g1 1 7ZI 5 1 b Email:
APPLICANT': l 1 V V I W, Mailing Address:
City: State: Zip: Contact No: Emai'
'Please fill out applicant information If different than landowner / ■ F�D
CONTACT NAME APPLYING IN OFFICE:61/�/1'1 U 1 f ,, Phone# N n "2"
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PROPERTY LOCATION:Subdivision: / T.1 €I VOt\W� ` Lot#'. 2- I Loott'S'ize:G `J J
State Road#'nc nQ r)3 StateRoadName: all O'ru _ o C't 'F L �H Map Book 8 Page: /NO/ /o ,1 U O
Parcel:��Q�A..Ilv���R"3 i"L 11 t 5 2\ AAA
/^, PIN: "qql�, —1�v to C1 b '204 - 0
Zoning:Mw12 Flood Zone: Watershed: AAA Deed Book 8 Page':73 I /(. 751kower Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Size x )#Bedrooms: #Baths:_Basement(wAwo bath): Garage:_Deck:_Crawl Space: Slab: Slab.
(Is the bonus room finished?( )yes (_)no w/a closet?( )yes (J no(if yes add in with If 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 )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:U Rooms: Use' Hours of Operation: #Employees:
33A. cpp3 2- pp Ir(/l1 p
IpiAddition/Accessory/Other:(Size��y� x : Use:SDF�. I[ r 4.a .p n\ /Z4 Closets in addition?(Styes ( )no
VWater Supply: County Existing Well New Well(#of dwellings using well )'Must have operable water before final
e
Sewage Supply:_New Septic Tank(Complete Checklist) v 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(5001 of tract listed above?( )yes ( )no
Does the property contain any easements whether underground
�orrooverhead(_)yes ( )no
Structures(existing or proposed):Single family dwellings( v-L Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks:' Comments:
Front Minimum Actual C.J'
RearS25_ c—>'
L
Closest Side ) ) 10 -1
SidestreeVcomer lot / vN/"1 A n/�tA
Nearest Building A I
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
•
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
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 accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
Signature of Owner or Owner's Agent Date
"it is the ownerlapplicants 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"
Residential Land Use Land Use Application Page 2 of 2 03111
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NAME: La Rfl V.1 '5(\ 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 I CONFIRMATION#
❑ Environmental Health New Septic SvstemCode 800
• All properly 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 al/for Central Permitting.
• Place orange Environmental Health card in location that is easily viewed from road to assist in locating properly.
• If properly 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.
024-Epvironmental 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 reouest.
• 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 system type(s): can be ranked in order of preference,must choose one.
( 4 Accepted (_I Innovative (_1 Conventional (_I Any
{_) Alternative I—1 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. If the answer is"yes",applicant MUST ATTACH SUPPORTING DOCUMENTATION:
{ )YES {ad Does the site contain any Jurisdictional Wetlands?
{ )YES {. NO Do you plan to have an irrigation system now or in the future?
{_)YES { NO Does or will the building contain any drains?Please explain.
{ ✓IYES { I NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
IIYES I P(NO Is any wastewater going to be generated on the site other than domestic sewage?
{ ES I_j NIs the site subject to approval by any other Public Agency?
{ }YES { NO Are there any Easements or Right of Ways on this property?
I—I YES { --(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 •ave 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 cessible So That A Complete Site Evaluation Can Be Performed.
PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) D14
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Post Office anBox 727 CAWdk Watson
Dunn,NC 25333 265 Bnenvood Place
• NC 21332
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NC Bar Nacional.Pa®Na 1.3 O 1976,Radad O 1977,2002
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EGIST ER OF DEEDS, HARNETf
W CORNELIUS HARNETT BLVD
SUITE 200
LIL GTON, NC 27546
FlNtl For Rag O&43:24 PM
Book: gm 7647!!
DoconRnl No.: � r
NC REAL ESTATE EXCISE TAIL:
Rowan:
Sato of North Carolina,County of Noma
KIMBERLY t HARGROVE,REGISTER OF DEED- `j)
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DO NOT DIS ' • -Ise
*2007009607 * 9
2007009607
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