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DOCUMENTS InNlal Application Date: //� )/Y> Application# I sx SL+1 L'e' I-1 V CW 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.hsmett.org/permits "A RECORDED SURVEY MAP,RECORDED/ DEED(OR OFFER TO PURCHASE)&SITE PAN ARE REQUIRED WHEN SUB/BITING A LAND USE APPLICATION" LANDOWNER: /JV-e.e") tot /7 Mailing Address: C? C.-,e....... rw..cf Cl..-, C City: /)u nn /State::tip Zip:d 433 YCantact No: / ,,Ff// Z6 Email: ) APPLICANT': J t e. P,.,t 4pi.4!.1 2'Mailing Address: 22 7 3 3' '/2 ,'/ , 6.+ City: i:/4 +((6L.. State:2- Zip) 700 Contact No: Y/# //Y 9.116 Emailt1 °RZGE CON.lrtwer 2W 'Plmse NI out applk3M information it different than landowner nn kr' /4/40, ,,A, CONTACT NAME APPLYING IN OFFICE: c/3//')N Re%c - Phone* ,9 r r/- r/A J 6 PROPERTY LOCATION:Subdivision: I4fr ,7/ Guy.) d Lot it: 3 Lot Size: / el State Road# e•,01' State Road Name: (oreert/ Eves I C(-z ' Map Book&Page: 919 / 696 Parcel: 010�. [Y$ o/Yb .L3 PIN: OS-7S -,3 - 37 t, 2'6, Lo Zoning:\ %Pc bFlood Zone: $ Watershed/vet Deed Book&Page:35Y /I3a Power Company': ay E....6/ 'New structures with Progress Energy as service provider need to supply premise number from Progress Energy. PROPOSED USE: Monolithic ❑ SFO:(Size_x )#Bedrooms:_it Baths: Basement(w/wo bath):_Garage:_Deck:_Crawl Space:_Slab:_Slab:_ (Is the bonus room finished?(__)yes (_)no w/a closet?( )yes ( )no(if yes add In with it bedrooms) ❑ Mod:(Size_x_)#Bedrooms_it 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?( )yes (J no ❑ Manufactured Home:_SW DW TW(Size x lit Bedrooms: Garage:_(site built?_)Deck: (site built? ) O Duplex:(Size_x )No.Buildings: No.Bedrooms Per Unit: ❑....����'''' Home Occupation:#Rooms: Use: /Hours of Operation: *Employees: XAddition/Accessory/Other:(Size 29 x (74.)Use, & /1- , /dFl) Closets in addition?( )yes Ana Water Supply: ✓ County Existing Well New Well(#of dwellings using well )'Must have operable water before final ✓Ex Sewage Supply: New Septic Tank(Complete Checklist) /isting 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 (k)no Does the property contain any easements whether underground or overhead( )yes 4k )no Structures(existing or proposed):Single family dwellings: yf.S Manufactured Homes: Other(specify): l N VCtd Se_ Required Residential PropertyZST�Line Setbacks:( Comments: I�n Z O Front Minimum -3S Actual RearIp�_ �- Closest Side Lc) ` Sidestreet/comer lot J Nearest Building J on same lot Residential Land Use Application Page 1 of 2 03111 APPLICATION CONTINUES ON BACK SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: t2+/J y2/ 7/Owed li: q I-e J. /< To -v Ja / may, //c w,joI � • Ff ,)n i:er , r-a-et7 (',rc/ t7`4,'.d .'ca. to ,s— If If permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such wort and the specifications of plans submitted. I hereby state that foregoing stateme are accurate rrect to the best of my knowledge. Permit subject ca'on if false information is provided. !mss aS IgngMFa of r naYa 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 N permits have not been issued" Residential Land Use Application Page 2 of 2 03111 .0.0.w nVL1402r\8690\V1Va 1 Z �. ®0181080 tmpOoW \1 O O CO 00 Q• ... f P°°o • ,° O i— 3 N V .-yY.. C �Oom 0 v j 0 L. 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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 W 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 given at end of recording for oroof of request. • Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits. 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 pet,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 given at end of recordino 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. [_) Accepted [ I Innovative (_) Conventional 1-1 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: [_)YES �.VX1.NO Does the site contain any Jurisdictional Wetlands? [_)YES NO Do you plan to have an irrieation system now or in the future? [ LYES /& l NO Does or will the building contain any drains?Please explain. XIYES tI NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property? f—LYES [>6 NO Is any wastewater going to be generated on the site other than domestic sewage? (JYES [,NO Is the site subject to approval by any other Public Agency? (_)YES fi,V NO Are there any Easements or Right of Ways on this property? [_}YES (X) 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 Properly Lines And Corners And Making The Site A b o That A C mplet Evaluation Can Be Performed. 1s PRO RTY OWNE OR OWNERS L PRESENTATIVE SIGNATURE(REQUIRED) ATE 10/10 HARNETT COUNTY HEALTH DEPARTMENT 18194 HTE# 05 500i4 ENTION OPERRATIONS PERNMENTAL HEALTH MIT , ___ p�Y� I&New Installation)2(Septic Tank 0 Repair Name: (owner) PropertyLocation: SR# tV 4 'Nitrification Line 0 Expansion Subdivision � rw oq Lot# 3 Tax ID # Quadrant# Registration# Contractor: G Basement with Plumbing: 0 Garage: IA Water Supply: 0 Well a Public ❑ Community Distance From Well: tW ft. Following are the specifications for the sewage disposal system on above captioned property. Type of system: ❑ Conventional OtherlitriVatepal Size of tank: Septic Tank: teed gallons Pump Tank: gallons No. of exact length width of depth of Subsurface 1 of each ditch 3CO ft. ditches 3 ft. ditches 18 in. Drainage Field ditches French Drain Required: Linear feet Date: �tlob PERMIT NO. Inspected byygetue aPrti 14. LW • 2 al g sce HARNETT COUNTY CASH RECEIPTS maw CUSTOMER RECEIPT mra Oper: IBROCK Type: CP Drawer: 1 Date: 1/26/18 52 Receipt no: 228895 Year Number Amount 2018 50843170 91749 TECH 2 LILLINGTON, NC 27546 B4 BP - ENV HEALTH FEES $100.00 EXT TANK JASON PRICE fender detail CK CHECK PAYMEN 1524 $108.80 Total tendered $188.88 Total payment $1@8.08 Trans date: 1/26/18 Time: 18:39:22 ** THANK YOU FOR YOUR PAYMENT am