DOCUMENTS tt 143
Ingle)Application Dale E2%/0 Application# 11'9)b ✓I
DRB# CU#
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Cantu,PUMNrp Weak*Its E Front Street Ulnp106 NC 27545 mYMny PO Box 135 ldgbn NC 27515 Fawn:teWWI 6034525ppWI x2 Fait(510)(1012703(1012703 .
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LANDOWNER: *Midi COanrii Mailing Address: Ia SG 6 4i ^{'*x•✓{
City: Sir s) 64ke • State:,N1l� Zip: Contact* Email:
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APPLICANT: WN7P• r yr/a/ ta. AN ((3 • . Mailing Address: PV &,,, 5131
Cny: Stnfoni/
State: 4rz ,:.2731/Contact# 919-770-.2C)3 Email: S«'Iottiercilsmta.JRIo,�y%E.o.•
• *KSS fill out applicant information n effort than landowner v
CONTACT NAGE APPLYING IN OFFICE: gr yaA £tHer Phone# '9/5-776'YSJD
PROPERTY LOCATOR:Subdivision: IO g6 Pork, Liyv✓e Lot#: Lal Size;
223
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State Road# -I• -�•.Tt�-I.r.•�SSMM Road Name: �KA/I' r. p. p{�1• (y �j Map Book&Page: IAAlT
/ICI IS
Parcel: OSS b I t•Dia AlPIN: �y--1I(.7I, -IIY- It-l4 SLI•00O
Zoning:M tr, Flood Zone: /x I A NJatemlWd: 'RI b Deed Book&Page To 1-1 / 5I LL Power Company': '
'New structures with Progress Energy as service provider need to supply premiseprumber o/� Iran Progress Energy.
SPECIFIC yr D.dc p
C DIRECTIONS TO THE FROM❑LLINGTON: flNd/ffea. C1ee L /0.00,74WAff�Yd
0411 I
•
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PROPOSED USE:
❑ Mull-Family Dwelling No.Units: No.Bedrooms/Unit: '
❑ Business Sq.Ft Retail Space: ' - Type: #Employees: Hours of Operation:
❑ Daycare #Preschoolers: #AlersGwplers: #Employees: Halm of Operation:
O Industry Sq.Ft:. Type: #Employees: Hours of Operation:
❑/AesSeating Capacity: #Bathrooms:" Kitchen:
aAcceMsptyiAddantner(Size Sx71 )Use: Pie cu5M•eh/ Arai
(*LI)
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Water Supply: _County —Seating Well _New Well(#of dwellings using well_) 'MUST have operable water before final
Sewage Supply: V New Septic Tank(Complete Checklist) _Existing Septic Tank(Complete Checklist Canty Sewer
comments: Acte..% 4o 44AA�.✓1,.t h/:rer le /ane2�/e Sed{4 peine.f AV l'iwsr
4./NGe 4,44 j r lee -hie GOVN4e
It permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state Thal foregoing statements are accurate
eaannd correct to the best of my knowledge. Penna subject to revocation I false Information is provided.
eVan
/Signature of Owner or Owner's Agent Date
•
' "This application expires 6 months from the Initial date II permits have not been Issued"
A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)AND PLAT ARE REOUMED WHEN APPLYING FOR LAID USE APPtICAfIDN
NAME: P ma.nAot 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,CHANCED,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 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 trip fee may be incurred
for failure to uncover outlet lid,mark house corners and property lines. etc. once lot confirmed ready.
• Atter 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 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 & select notification permit
if multiple permits, then use code 800 for Environmental Health inspection. Please note confirmation number
given at end of recordinq 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.
1-1 Accepted (_) Innovative Vj Conventional (_1 Any
1I Alternative (_} 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 1"V NO Does the site contain any Jurisdictional Wetlands?
(_}YES (KJ NO Do you plan to have an i0]eation system now or in the future?
(_)YES ixy4 NO Does or will the building contain any drains?Please explain.
)YES I'\t No Are there any existing wells,springs, waterlines or Wastewater Systems on this property?
1—IVES (X) NO Is any wastewater going to be generated on the site other than domestic sewage?
KEYES 1_1 NO Is the site subject to approval by any other Public Agency?
1 )YES Ki NO Are there any Easements or Right of Ways on this property?
1_IYES iS1.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 Understa•d That I Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site /cessible So Th•t A Complet ite /ablation Can Be Performed.
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PR 1. •' T t 1•� NE-RS OR 1 T' EGAL REPRESENTATIVE SIGNATURE(REQUIRED) D E
10/10