DOCUMENTS nal Application Dale \_a_4_`�tk�
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COUNTY OF PARSE TT RESIDENTIAL I_SND USE APPLICATION _
central Perminmg 1D2 E. Front Street Lilhnglon NC 27545 Phone(et Di„93-7525 eq:2 Fax:(910) 2932793 v,„
-d org/perrrps
"f RECORDED SURVEY MAP RECORDED DEED IOR DEFER SR PURGhFSF)&Sfi6 PLAN ARE REQUIRED'WHEN SUBIAITI ING A LAND USE ADPL IC0.TIDN'
I Mt/DOWNER'_
----- Pailng Address__ S x e_ CEAD
Orly: /r _ Stale A Zip ���
COolad No _ Email
APPLICANT` -ft. G.." Mailing too ess 7
eysef� `��n_ Stat eC Zip ponaC, No 9j0 _S:-1e 5/Smail -
PP fsn-aliR Efferent than:a vn/er //���/// :�JI(R/////J//YS/Ffs7�9 y�l,W.COrf.
CONTACT NAME APPLYING IN OFFICE Alt ('L(� a,e G� Phone 9 (///fl 89�- 425 .475—
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PROPERTY LOCATION: Subdivision( LG (es Levtz-- R J
Slate Road z �j� 18 Stale Road Name O� (�,,/ - _Lot d' Lot S:ze__�3
State Road
D O ' Stale�C�`Y ` 0 )1 ` of Map Book.4 Page'a'p�1 4pl
,f �/ PIN CAO n_ o raq _ `� F
Zoning Al 3 loon Zone: /Y, Watershed:_/ 1' [( ow
Deed Book @ Page'_ 1py 3
'Now structures with Progress Energyer Company`
as service provider need to supply premise number
- from Progress Energy
PROPOSED USE:
M SED-(Size CA) v1 I Z Bedrooms;n. #Baths aasement(w/wo bath : Crawls ace: MonolWiic
) Garage:!Deck p _ Slab. Slab'.__
(Is the bonus room finished'( 1 yes LJ no w/a closet'r 1 yes L.no(if yes add in with z bedrooms)
O Mat(Oce_ _x )If Bedrooms z Baths Basement(w/no path)_Garage
(Is the second floor finis bedsi—Site Built peck: Fame 05 Frame
U yes ( )no Any amen site built additions'( yes) ( i no
▪ Manufactured Home: SW OW TW(S.ze
x _)X Redioomr.^ Garage _(site puilq )Derk: (site built.;
O Duplex:(Size 7 No. Buildings _No Bedrooms Per Unly._
O Tome Omupalion:9 Rooms:
Use- Hours of O
an
J AdditionACCessory/Omer(Size )use
:
� x ----- -- Oloscis.n addntorn lyes t
Water Supply: 1y _ mly Existing Well New Well
(k of dwellings using'.ve// )'Must have operable water baron[final Supply: VNew Septic Tank(Complelp Checkl¢/) Existing Seppc Tank(Complete Cbecklsl) _County
Does owner of this pact of land own land:nal contains a mantfiactu:eo tome Whin Lve nun:red real(500') of tract[sten aboveSewer
Does the properly e LJ yes ( V)no
y contain any easements yMetber unoergmuaE a overhead U yes U no
Structures(existing .t pro --d)'.Single family Dwellings
_4____Manutaclurfrd Hames: Other IspeNfyJ
Req Lined Residential Proper,)Lice Setbacks: Comment:
Front Minimum_3 Actual_
Rear c °
Closest Side /0
Sidestreelcomer lot 290 - —
Nearest Building /
on
�//'
sane lot
Kes nen'al Land Use 4ppliLLwn
'Sge1012
APPLICATION CONTINUES ON BACK °yl'
SPEr4{-IG DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
l .. _
d permitsare granted I agree to conform to all ordinances and I. of the Slam of North Carolina regulating such work and the specifications of plans submitted.
I herebystate that(ore_. g statem. Is are accurate and,orre the best of my knowledge. Permit subject to revocation if false information S provided_
lk
9nature of Owne e --
Date
"ht is the owner:applicants responsibility to provide the county with any applicable information about the subjact 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 Application
Race 2 of 2
(cell
CUMBERLAND HOMES, INC.
THE SALEM IV W/ 3RD CAR GARAGE
LOT * 3 LAFAYETTE ROAD
SCALE: 1"2140'
SITE PLAN APPROVAL
DISTRICT USE v,
MBEDROOMS -4:151" c.�\0 "
Smile A�5 0
o.� o
S
4 o
had m
h rn
Iram
11 20,_0„
S 57 29' 54.0000" W 300'-3 1/2"
LAFAYETTE ROAD
NAME elk Lk A0 ,APPLICATION b:_
=This application to be Filled out when applying fora 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 AI.TERED,THEN THE IMPROVEMENT
PERMIT OR AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID The Ths mimic is‘and rut etther 60 tarda or ya thaw cxpratiion
depending upon documentation o uucd (umpl etcste plan 60months-ramp a plat without expiration)
a910-893-7525 option
CONFIRMATION;
Environmental Health New Septic System Code 8 00 - - --
• All property irons must be made visible. Place"pink p roperty flags' o n each corner i ron of lot All property
lines must be clearly flagged approximately every 5D test between corners.
• Place`orange house corner flags" at each corner of the proposed structure. Also flag driveways, garages, decks,
out buildings, swimming pools, etc. Mace flags per site plan developed at/for Central Permitting.
• Place orange Environmental Health card in location that is easily viewed from road 10 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 fee may be incurred
for failure to uncover outlet lid, mark house corners and property fines. 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
BOO (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.
_i Environmental Health Existing Tank Inspections Cod e 800
• Follow above instructions for placing flags and card on property.
• Prepare for inspection by removing soil over over outlet end as diagram indicates, and lift lid straight up (if
possible) and then close back down. (Unless inspection is for a septic tank in a mobile home park)
• After uncovering outlet end call the voice permitting system at 910-893-7525 option 1 & select notification permit if
multiple permits,then u se code BDO for Environmental Health ins pection. Please note confirmation number
given at end of recording for proof of request.
• Use Click2Gov or VR to hear results. Once approved, proceed to Central Permitting for remaining permits.
SEPTIC
If applying for authorization to construct please indicate desired s.nem type(s). can he ranked in older of preferencemust choose nue.
{_} Accepted { } Innovative (-4-Conventional { i Any
{_} Alternative { } Other
The applicant shall notify the local health deparmtent upon submittal anti:Is application if any of the following apply to the property in
question. lithe answer is"yes", applicant must attach supporting documentation.
(_IYES {,}-NO Does the site contain any Jurisdictional Wetlands?
( IYES { NO Do you plan to have an iayjon system now or in the future?
{ }YES Lai NO Does or will the building contain any drai Please explain.
__LYES ( Al NO Are there an) existing wells,springs, waterlines or Wastewater Systems on thiso ?
Pr per,ty.
'_}YES .NO Is any wastewater going to be generated on the site other than domestic smudges
( fYES { 4 NO Is the site subject to approval by any other Public A gent)?
}YES { INC Are there any Easements or Right of Ways on this properp:?
(_[YES {A NO Does the site contain any existing water. cable_phone or underground electric lines?
If yes please call No Cuts at 600-632-4949 to locate the lines. This is a free service
I Have Read This Application And Certifi'That The Information Provided H Ir.True.COT plete And Corrreg A uthoriged County And
State Officials Are Granted Right Of Enrm To Conduct Neeessar, Inspections Tr DetermineCompliance With A ppltcble Laws Arid Rules.
I Understand That I km Solely Responsible FThe Proper Identification Ad LI ling Of All Property Lines And Corners And Making
The Site Accessible So That A Complete Site Evaluation Can Be Performed.
44 v\/7
PROPERni r Sal A•S LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) ' D/EI /
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