DOCUMENTS ruccm__----
Initial Application Date: 2' I S _I' Application# IR`5C01-13934
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Central PemWUng 108 E.Front Street,Longton,NC 27548 Phone:(910)893-7525 ext:2 • Fax:(910)893-2793 www.bemett.org/permge
"A RECORDED SURVEY NIP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE RAM ARE REQUIRED WHEN#UEIRTIRIG A LAND USE APPLICATOR'
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LANDOWNER:"Oirrtky` a�r;aft #.1% d't 011%i3wn Mailing Address: 11 17(1.114,‘ loop aqui
Cly. `N'^^ `JJ State:NC- Zip:2.8Zi`Y Contact No: Emelt
APPLICANP: u:IInml Address: 11.04 N. hit :,—.. .S+•
City: L.R:..}L r Stat.tlC. 20.1194L Contact No:<110-89z-in, Email 03 iltrn ciashhe qNM I&tcm-t
'Phew M oil Mammas'l deem*then leidw cwi- �v^^ II (/
CONTACT NAME APPLYING IN OFFICE: &TS Since-TVG( Phone# 910 AS S' i1317
PROPERTY LOCCA(TI3ONN:Subdivision:
n {. ,t Lot N: Z Lot Size: 1
I ,I 1
State Road* $408 Stab n Road Name: Sumps�S Creak Acr/SS Map Book&Page: /
Parcel: O(oo59(e) (It yIle OS PIN: 0596- *70-aglono
Zonineslaa V(%od Zone: h- Watershed: AADeed Book&Page:2241 /Olen Power Company: pi*VCo
'New seams with Progress Energy as service provider need to supply premise lumber from Progress Energy.
PROPOSED USE:nn / MtM WP((
thic
❑ SFD:(SSe DD x(co )#Bedrooms:LI #Bats:S_Basement(w#n hath):41 ✓ ✓y Slab:_
slT Garage: Deck:_Crawl Space:_Slab: Mono_
(le the bonus ram Milled?(J yes (_)no w/a closet?(J yes U no(t yes add M with#bedrooms)
O Mod:(Size_x_)#Bedrooms #BathsBasement(whim bath) Garage:_Site Built Deck: On Frame_Off Frame_
(Is the second floor finished?(J yes (_)no Any other site but additions?( )yes ( .)no
❑ Manufactured Home:_SW DW 1W(Size x )#Bedroom:_Garage: (Ste built? )Deck: (site built?_)
O Duplex:(Size_x_)No.Buldkge: No.Bedrooms Per Unit
O Home Occupation:#Rooms: Use: Naas of Operation: /Employees:
D /ddtlon/Aaa/my/ addition?er(Size_z )Use: Closets in addition?( )yes ( )no
Water Supply. •. _EzbWg Wel New Wet(#ofdwr#mgs using well )'Must have operable water before Mal
Sewage SWISS: New Septic Tank(Complete Check/SO Existing Sepik Tank(Complete Checklist) _County Sewer
Does owner of this tract of lend,own land that contains a manufactured homewit/hp five hawed feet(500')of bald listed above?(J yes (1/)no
Does the property contain any easements whets undergroundor overhead(V)yes ( )no OVpr�4.0 F WY \1WS
Sheati
udures( ng Or Proposed):Single family dwellgs: ✓ Manufactured Homes: Other(specify):
Required Residential Property Lime Setbacks: CamrerW:
Fond Minimum egi S Actual II
Rear /. is Q.L�.S t
Coast SMB I f)1 3[Ll—
Sldestree#rmsr lel
Nearest Balkans
let
on same lot
Residential Land Use Application Far I of t 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINOTON:
If permits am granted l agree to conform to al ordinances and laws of the Stale of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing stta! are accurate
cm mteandd coned to
the best of my knowledge. Pam*subject to revocation if false information is provided.
Signet tare of Owner or Owners Agan '2'
mit 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 Cr.not responsible for any
incorrect or missing Information that is contained within these applIcatIons."'
'Mils application expires 8 months from the Initial dots N permits have not been Issued*'
Residential Land Use Application Page 2 of 2 03111
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DATA\0596\18020551 M.G.G.
f
NAME: 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 SystemCode 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 proof 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 put 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 recording for Drool 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 desire stem type(s): can be ranked in order of preference.must choose one.
{_} Accepted 1I Innovative { Conventional I ) Any
{_} Alternative { I 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 ans er is"yes",applicant MUST ATTACH SUPPORTING DOCUMENTATION:
{_IVES { O Does the site contain any Jurisdictional Wetlands?
I /YES (_) yO Do you plan to have an irrigation system now or in the future?
(_IVES {V/I )JO Does or will the building contain any drains?Please explain.
{ )YES II Are there any existing wells, springs,waterlines or Wastewater Systems on this property?
I }YES {_ NO Is any wastewater going to be generated on the site other than domestic sewage?
{NAVES 1I NO Is the site subject to approval by any other Public Agency? Ce...1rw1 k r:I IC
{\/YES 1_I NO Are there any Easements or Right of Ways on this property? �\.•JJ
{ )YES 1/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 That A Complete Site Evaluation Can Be P• formed.
A.A.4 I
PROPERTY OWNERS I R OWNER LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) —Y---.) 45.—E
10/10
%g - oaa -do
Town of Erwin
No),
Permit 1
‘...,Mr.'nZoning Application & Permit
f/akS Planning&Inspections Department
rtevsepanl
Each application should be submitted with an attached plot/sibe plan with the proposed use/structure showing lot
shape,existing and proposed buildings,parking and loading areas,access drives and front,rear,and side yard
dimensions.
Name of Applicant
S i�sem+• ttuwtr.. [{widflS Property Owner flrte.. d- rh., r�[ tT iw9an
Home Address 12o, nI. Met. S+ Home Address 131nA
R .t ter Road
City,State,Zip LIU tors bk vis -Us City,State,Zip
Telephone Din" AIL 2833Y-
910- q6 S-tt36 Telephone
Email CSherroi.skbiJ aw:l.am Email
Address of Proposed Property W
Parcel Identification Number(s)(PIN) 059(0,''ID-- (leis 0 e a Estimated Project Cost
What is the applicant requesting to build/what is 300/to a
the proposed use of the subject property? Be specific.
Nea ser ,+^ u
to the
Description of any proposed improvements
to the building or property
What was the Previous Use of the subject property?
Does the Property Access DOT road? Yes -- —_—.
Number of dwelling/structures on the property already , Property/Parcel/size [pp•e7(
Floodplain SFFiA_Yee✓No Watershed Yee o Wetlands_Yea o
MIST circle one that applies to property Thdstin roposed Septic ystepy? Or
Existing/Proposed County/City Sewer
Owner/Applicant Must Read and Sign
The undersigned property owner,or duly authorized age a/representative thereof certifies that this application and the forgoing
answers,statements,and other information herewith submitted are in all eapeda true and correct to the best of their knowledge
and belief. The undersigning party understands that any incorrect information submitted may result in the revocation of this
application. Upon issuance of this permit,the undersigning party agrees to conform to all applicable town ordinances,zoning
regulations,and the laws of the State of North Carolina regulating such work and to the specifications of plans herein submitted.
The undersigning party authorizes the Town of Erwin to review this request and conduct a site inspection to ensure compliance
to this application as approved.
Print Name Signature ofOwner or Representative Date
For Office Use
Zoning District 4O Existing Nonconforming Uses or Features I
FraYard Setback ,I J c Other Permits Required I _Conditional UseXHtdiding _Fire Marshal /
Free Other
Y Requires Town Zoning Inspection(s) I _Foundation _Prior to C of O.
Side Yard Setback LA% Zoning Permit Status I )(Approved
-
Rear Yard Setback _Derif
4 > Pee Paid: - —1 Date Paid: Staff Initials:
Comments
fleet) c,Max,' fig 1Iv/^Pil C0w71y fi SPf/ C I" C.
ISignature of Town Representative: �( i : Ap wed/Denied: ,2/6/1)/,2/6/1)/PIP
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P e,4q (of A 5ep1jC 14/./c
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HARNETT COUNTY CASH RECEIPTS
*** CUSTOMER RECEIPT ***
Date: TRUCK
2/86/18 52 Receipt P
eiptn e: CP :ra242107
Year Number Amount
2018 50043234
35315 *UNASSIGNED
DUNN, NC 28334
B4 BP - ENV HEALTH FEES
NEW TAM $758.BB
SIGNATURE NONE
Tender detail
CP CREDIT CARD $750.00
Total tendered $758.80
Total payment $758.88
Trans date: 2/06/18 Time: 15:11::23
** MANX YOU FOR YOUR PAYMENT **