DOCUMENTS Initial Application Date: t d p0)
l Application# I' 1 C..30D T 3 Q
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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.harnett.orglpermits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFF{RTO PURCHASE)fl SITE Py N ARE$EOUIRED WHEN SU§MITTING A LAND USE APPLICATION"
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LANDOWNER:WNER &7 qt*L/ -/YtC_ ( Mailing Address: ,/ /J �
City: /Art/•t+f y''/✓ / Slate:/�-Zip: . 75 ontact No: �/9112-Y/7.-' Email: erre-❑ 44 �,^'u'1d+•.1,
APPLICANNr✓✓: J-t^oy ` Mailing Address L2 E.
city: /r'✓�7f'/-Q/✓ // State:/fl -Zip: 1/fVContact No: 2' Y11"�/��mail:
'Please fill o plicant Information It different than land
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CONTACT NAME APPLYING IN OFFICE: J /Pz" 6Z e'y D7 Phone# // — /ray — O /30
PROPERTY LOCATIOON:Subdivision: ,./ Lot#. 3 Lot Size. •t.41
State Road# I,3 Pito State Road Name: SS Map Book 8 Page: /9/S/ .Z07
Parcel: /�O OLIO la 3 006'0 PIN: Ole92- -12-52/3. Ooo /�
Zoning: r^'� Flood Zone: Watershed' -Deed Book 8 Page: /9/c I707 Power Company'. rat
New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
./ monokniu
EJ ./SAD:(Size a(r x 1/ )#Bedrooms,#Baths Basement(wlwo bath): Garage: Deck:d 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_Of 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 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: I-7-New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) _County Sewer
Does owner of this bad 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 (—)no
Structures(existing or ropose . Ingle family dwellings: Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum Actual
Rear CA0
Closest Side 90.5-
Sidesueet'corner lot
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
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If permits are granted I agree to conform to all o ]inances nd laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that for:.:' . .- ements area*irate correct to the best of my knowledge. Permit subjectTto revocation if false information is provided.
/l -92-17
nature of Owner or r' gent 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,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 Issuer
•
Residential Land Use Application Page 2 of 2 03/11
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DATA\0692\171201GR M.G.G.
Derrick Gregory
3-Bedroom Conceptual Plan
3436 NC 55 W
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System'. Gravity to D-Box
Lines: 1-4(2405
0.4 LTAR
18"Trench Bottom
Accepted Status System
Repair: Gravity to D-Box
Lines: 5-8, (240')
0.4 LTAR
18"Trench Bottom
Accepted Status System
GRAPHIC SCALE Adams
1" = 50' Soil Consulting
50 0 50 100 919-414-6761
— J Job #555
NAME: APPLICATION k:
•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 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 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 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 aiven at end of recording for proof of request.
• Use Click2Gov or IVR to verily results. Once approved, proceed to Central Permitting for permits.
Environmental Health Existino Tank Inspections Code 800
• Follow above instructions for placing flags and card on properly.
• 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.
SEPTIC
If applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference,must choose one.
1—) Accepted t_) Innovative II Conventional
II Any
I Alternative I) Other 2-
The applicant shall notify the local health department upon sub ittal of this application if any of the following apply to the property in
question. If the answer is"yes",applicant MUST ATTACH SUPPORTING DOCUMENTATION:
IVES I 'I NO Does the site contain any Jurisdictional Wetlands?
YES 1_4;0 Do you plan to have an int Atjong�s sign now or in the future?
ILIYES II NO Does or will the building contain any drains?Please explain. / r y ,Mira
✓IYES l—I NO Are there any existing wells,springs,waterlines or Wastewater Systems on this properly?
e Ord 4 a-
i_IYES Is any wastewater going to be generated on the site other than domestic sewage?
I—IVES I
-IND Is the site subject to approval by any other Public Agency?
I—I YES I„)-NO Are there any Easements or Right of Ways on this property?
{_DYES (-'RO 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
Slate Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I understand That I Am L lely R I msible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The to Ac•.•: , e S /at i,m. eta Site E .lualion Can Be Performed.
PROPER YO NE• IR I LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) /ATE -/7
10/10
HARNETT COUNTY CASH RECEIPTS
aaa CUSTOMER RECEIPT $ma
Uper: SBROCK Tyne: CP Drawer: I
Date: 12/22/17 52 Receipt no: 194909
Year Number Amount
2817 50042991
91749 TECH 2
L/LLINGTON, NC 27546
BP - ENV HEATH FEES
NEU TAM( $750.00
GREGORY CONST
Teail
CPnCREDIT der tCARD
Total tendered $750.82
$758.80
Total payment
f75B,BB
Trans date: 12/22/17 Time: 12:54:31
as THANK YOU FOR YOUR PAYMENT **