DOCUMENTS Initial Application Date: 103)1 D ) J "1 Application# In c t-itad1 ei.3
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COUNTY OF HAMMY RESIDENTIAL)AND USE APPLICARON
Central Permitting 108 E.Front Street,Ullington,NC 27598 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.hamettorg/permits
Lir "A RECORDED SURVEY MAP RECORDED/ (�
� DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER:InJ OO S LLA_,Lka Q.-I VI SOYT Mailing Address: 1 4 -7 ry �ITO le Sten 14 P4
City: 1 )VO a\uS P I
State:t'C _Zip 7(.0 f Contact No: /�
Email:
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l- .%)a 1y1C1rnq VS Mailing Address: P\ LJO/ 875" ll
City: Jv0CL .&&.)ayy State: C Zip .1 SOS Contact No: 9 i q\ Dix 4069 4 iv n C
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*Please fill out applicant'nlormatioi if different than landowner JJ ^1WI n,$1'v Rom, y‘44,
CONTACT NAME APPLYING IN OFFICE: `� (� yyyy�U,. ��_��_ Phone ft p
\ PROPERTY LOCATION:)Subdivision: (WC-X.. c. f 4 (�I�(; �j Lot N: Lot Size: ) •5 (� CC
State Road#1a1 ) State Road sal l"I'VII 11 S(]f I PIN: 10V\ ��cl� I O.� �pB�� � ORO I7/ af 0)
Parcel: Y3gla91 ona3 VD � //�� 1 C I
Zoning:} Flood Zone: ?C Watershed:MI Deed Book 8 Page: I 3 / 1-16-) Power Company:R‘ Cc Y e C
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*New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
r, rd '2 �/ Monolithic
SFD:(Size( x H #Bedrooms 1#Baths:_L Basement(w/wo bath):—Garage: K. Deck:_Crawl Spacer Slab:_Slab:_
(Is the bonus room finished?(LJ yes I )no w/a closet? ( 1 yes L.)no(if yes add in with R bedrooms)
kivir Mod:(Size x )N Bedrooms_#Baths Basement(w/wo bath)—Garage:_Site Built Deck:_ On Frame_ON Frame
(Is the second floor finished?I 1 yes U no Any other site built additions?U yes U no
❑ Manufactured Home: SW_DW TW(Size x )#Bedrooms:_Garage: (site built? 1 Deck: (site built? )
❑ Duplex:(Size_x I No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use: Hours at Operation: #Employees:
O Addition/Accessory/Other(Size_x )Use: Closets in addition?U yes ( 1 no
Water Supply: ! County Existing Well New Well(#o/dwellings using well )'Must have operable water before final
Sewage Supply:SI 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 property contain any easements whether underground or overhead( )yes (Y1 no
Structures(existing proposed): ingle family dwellings: Manufactured Homes: Other(specify):
Required ResidentialalProperty Line Setbacks: Comments:
Front Minimum JS Appall-1 I ,(1:
Rear aS C'-1.Ci
nlasest Side 15 V3.L1
`nsuillingr lot
Nearest Building
on same lot
Rasidennal Lend Use Application Paget of 03111
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Lf � , IV• - r t y , Vi; (1�())/a- - 1fYm
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If permits are granted I agree to conform to all ordinanc s and laws of the State of NorthCarolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing statements are accu nd correct to the best of my knowledge. Permit subject to revocation if false information Is provided.
7
Signature of Owner or Owner's Agent Data
"1t Is the owner/applicants 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"
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Residential l and Use Application Page 2 of 2 03/11
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SITE PLAN ppnovAL d\ h/ )
�R USE �� /\/ \ !
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NAME: APPLICATION/I:
*This application to be filled out when applying for a septic system inspection.*
(heirCounty Health Department Application for Improvement Permit and/or Authorization to Construct
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 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 trio tee may be Incurred
for failure to uncover outlet ltd.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.
❑ Environmental Health Existlna 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 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.
iilhairSEPTIC
If applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference,must choose one.
I—) Accepted {—j Innovative { .} Conventional {-1 Any
(_) Alternative 1-1 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:
I_)YES N I NO Does the site contain any Jurisdictional Wetlands?
{_IVES Ix1 NO Do you plan to have an irrigation system now or in the future?
{_)YES {XI NO Does or will the building contain any drains?Please explain.
IYES ( 1 1 NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
{_IYES 01 NO Is any wastewater going to he generated on the site other than domestic sewage?
I_IYES (.1 NO Is the site subject to approval by any other Public Agency?
{—IYES (�) NO Are there any Easements or Right of Ways on this property?
{_)YES ( I 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 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 So Th A Complete S e ation Can Be Performed.
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`.PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10