DOCUMENTS FA S ntL3-.L(
Initial Application Dater I S ' I o Y Application# C
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 1D8 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext2 Fax:(910)893-2793 www.harnett.orgIpermits
"A RECORDEDSURVEYMAP,RECORDED DEED(OR OFFER TO PURCHASE)8 SITE PLAN ARE/REQUIRED WHEN SUBMITTING A�LAND USE APPLICATION"
LANDOWNER: _NoxtW+n)tt `�, "`F•S01 Mailing Address: I�GO( 11l4i�Ax fsb'�I
City �.zdrtilk
state: A)L Zip: OTContact No: WO"311"ISSN Email: a-f'pfi^2(30,d Q rd. rd.."-s
APPLICANT*: ‹M4 Mailing Address:
City: State: Zip'.
Contact No: Email:
*Please 011 out applicant information if different than la
ientlownar
CONTACT NAME APPLYING IN OFFICE: Phone#
Lot#: I Lot Sae'C9
PROPERTY LOCATION:Subdivision: t.--_- fad c' Map Book 8 Page:CCr
CS
State Roa1d# 1 S I 0 State Road Name: IN C�c, 11- s—
4 5— 5 p — 30` / •
Parcel: P
(� !���--�s,�����77b SV Ou3 5 A ,,II UU� s� �
Zonin?S\a alood Zone: f Watershed:/) Deed Book 8 Page:3T-•o 5_ Inpower Company*:
*New structures with Progress Energy as service provider need to supply premise number
from Progress Energy.
PROPOSED USE: Monolithic
LR OPSFD:(Size 70x GO)#Bedrooms:5 #Baths:'l Basement(wlwo bath):_Garage:Y Deck: e'Crawl Space:X Slab:_Slab:_
(Is the bonus room finished?(—)yes (—)no wl a closet?(—)yes ( )no(if yes add in with#bedrooms)
O Mod:(Size_x_)
#Bedrooms_#Baths Basement(wM'o bath) Garage:_Site Built Deck:_ On Frame_Off Frame_
(Is the second floor finished?(_)yes ( )no Any other site built additions?(_)Yes (—)no
E Manufactured Home: SW DW TW(Size_x )
#Bedrooms: Garage:—(site built? )Deck: (site built? )
• Duplex:(Sizex )No.Buildings: No.Bedrooms Per Unit:
CD Use: Hours of Operation: #Employees:
Home Occupation:#Rooms: 2 .ysa--
,.A `,` Use_ Closets in addition?( )yes (_)no
�N AdtliticnlAccessarylOther.(Size3� x� :��
Water Supply: County Existing Well )(New Well(k et dwellings using well
I )'Must have operable water before final
Sewage Supply: X New Septic Tank(Complete Checklist) —Existing Septic Tank(Complete Checklist) County Sewer
Does owner of this tract of land own land that contains a manufactured home within five hundred feet(5003)of tract listed above?(_)yes (X)no
Does the property contain any easements whether underground or overhead(_)yes (X)
no
Other(specify), C
Manufactured Homes: ( P fY) fir/ I
Structures(existing or proposed):Single:family dwellings: k5lt10
Required Residential Property Line Setbacks: Comments:
.Comments:
Front Minimum. �-+.Actual O •. •&►a • • �e`-
Rear \\° N t �f �
Closest Side 1 VVV \ A
gra. Alk . C • �.� V
SldestreeVcomer lot ' "
Nearest soilding •` 4. � Vis`Iji 1 [zSIE.
on same lot (_,rl 3 of l O
Resitlen\ial Land Use Application '
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: _Or 2/i) TP...dFp� �P r n
1,-,k, . Dr iv, on kik- 1,,,k s;cee,
ILL - . .L. •�q 4
F^� qIA -/� °icl
kect 6,,IX c;4__ s I / & p � die.(.....n7/
If permits are granted I agree to conform to\ ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing ytgtements are. rate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
/,(/`I/�jSignature of Own `•r s Agent — 3/Yr/�
Da e
•
"'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 ape 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 Page 2 of 2
03/11
NAME: ALL AM( r(040o/( 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-S93-7525 option 1 CONFIRMATION#
pEnvironmental 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 underarowth 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 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 des' system system type(s): can be ranked in order of preference,must choose one.
1—I Accepted ( ) Innovative (/W('onventional (_) Any
(_) Alternative 1_1 Other CC„
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 (_ NO/- Does the site contain any Jurisdictional Wetlands?
{_DYES 1_," J�..Np Do you plan to have an- i now or in the future?
.
•
1 W}YES ( rvO Does or will the building contain any drains?Please explain.
1—IVES LI_wO Are there any existing wells,springs, waterlines or Wastewater Systems on this property?
{_}YES ( ✓i NO - Is any wastewater going to be generated on the site other than domestic sewage?
1_IYES (✓) NO i Is the site subject to approval by any other Public Agency?
----
{ }YES (. }-4O
. Are there any Easements or Right of Ways on this property?
(_)YES 1-.FNO 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 olely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site Ac Able So Th A Complete Site Evaluation Can Be Performed.
1
PRO RTY OWN ORO GAL REPRESENTATIVE SIGNATURE(REQUIRED) 'DATE
10/10
Harnett County Department of Public Health
Well Construction Permit Application
If the information in the application for a Well Construction Permit is falsified,
changed,or the site is altered, then the Well Construction Permit shall become
invalid.
r\ APPLICANT INFORMATION
i-Jotkitarit(( ace) (WO ) -Il-lam"`(
Applicant/Owner � �" Phone Number
WOO( ' 2-t 4 lets r'yclici tc ,(k- aX305
Street Address,City,State,Zip Code
The Applicant must submit a Site Plan. The Site Plan is a map/drawing of the property and must show:
1.existing and/or proposed property lines and easements with dimensions;
2.the location of the facility and appurtenance;
3.the location for the proposed well;
4.the location of existing or proposed sewer lines and/or sewage disposal systems within 100 feet or the proposed well;
5.the location of any existing wells within 100 feet of the property;surface water bodies;
6.above ground and/or underground storage tanks;
7.and any other known sources of contamination within 100 feet of the proposed well site.
The Applicant shall notify the Harnett County Health Director through or by way of the Harnett County
Division of Environmental Health if any of the following occur prior to well construction:
I.there is a relocation of the proposed facility;
2.there is a change in the intended use of the facility;
3.there is a need for installing the waste water system in an area other than indicated on the well permit;or
4.there are landscape changed that affect site drainage.
Contact information: Environmental Health Division-910-893-7547
PROPERTY INFORMATION
/ Proposed use of well
Single-Family[ MultifamilyL Church L Restaurant El Business L Irrigation L
Street Address 1373 (J4kr RR Subdivision/Lot#
Parcel#\a 1D-5{S bb3S PIN# bS**S — S'S-v-sSzm
/\ A Directions to the Site p�
141 ,4. ./04/14L?alter-See-44M ed- KSiny�la^ Alc-C-hh,.,b r (-Ler a
___ ,..—.F__,..5.1- Coe. „F la.
I have thoroughly read and completed this Application and certify that the Information provided herein is true,complete and
correct to the best of my faith. Representatives of the
arnett County Health
state officials are granted right of entry to conduct ge and Is give in necessary inspections to determinecompliancetwith applicable rules. and
I understand that I am sal. responsible for the proper identification and labeling of all property lines.underground wing.,lines,and
making the site accessible that a will can he properly constructed according to the permit
yr ik
Property Owners of Owner's Legal wive •nature Required ayel
NOT FOR LEGAL USE .
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ER.EG a W-03 FEE pt et RECO ENATION OF PROPERTY OF:
1 Y[ FApL(p CER THAT TM IS IlC/1 Iy�1 '011)11 SULCER
3. LIF SUPERVISION:
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PLOTTED FROM 117 AM710N 70UND IN 10011 *W W (' TEW T'S C K TOWNSHIP
P000 1 THAT THIS PLAT WAS PREPARED IN ILSIGNATUR
WITH 0. S. 47-30 AS MENDED. WITNESS MI ORIGINAL SIGNATURE / HH TT C NORTH CAROLINA
Lc, NUMfR AND SEAL THIS DAL DAY C< __SKIT-_20_2L_-__ / �71NR• -4 PARCEL ON 1200460115
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' I. RODNEY E. FARMER. NCPLS L-316 f L3116 THAT ire NIP 01 PLAT 10 FI0N TH11 aMT),MATIp SakE:l�.•r
HERE6V CERTIFY THAT THIS PLAT IS OR t. j 6 Of IIID RE Ts ALL STATUTORY R(CUIM(KMI.FOR RECORDING. �J/J
A SURVEY THAT CREATES 1 RECOM INATI0(lY 90 /2L Lr�'JII .. _ 100 0 *JEW 200 300
(01011NT PARCELS OF LAND. THAT ARE 100IRATEO E TSN 111(1)ft OPP1 16131LMRY(0.lJ =--�-
rr . II COUNTY OR MUNICIPAL Ill ORDINMCE THAT
co
REWLATES PARCELS LAW. GRAPHIC SCALE ET
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HARNETT CpM/R TY�. 'N.N.C. 1' FARMER P-• r'=ON)JC S
P E0 DATE?.41,1L3
(Qi-_Claq3�_TILE _4311.2-12h: RODNEY E. - T. IN..NCP ��
Q]�`00 2 Toll DIVISION OF PROPERTY IS 1232 NORTH '
01011105 177 DEEDS 11EW1 PROM THE HMNETT COUNTY LIIIINGTON,NC LI
n
IMEALY 3. HARGROVE 1015151 OE0ULA710NS.'�-V3 TEL(910)-893—AIQ4
A _ I_ �___J��Vn( DATE DNR LOO 03-44
Or: _____( OfPUTY _I-- LATER I MAP 03-44
HARNETT COUNTY CASH RECEIPTS
rmm CUSTOMER RECEIPT rxm
Opel,: JBROCK Type: CP Drawer: 1
Date: 3/85/18 52 Receipt no: 273185
Year Humber Amount
2818 50843468
91749 TECH 2
LILLINGTON, NC 27546
B4 BP - ENV HEALTH FEES
6758.88
NEW TANK
2018 50843468
91749 TECH 2
LILLINOTON, HC 27546
84 BP - ENV HEALTH FEES
$258.08
NEW WELL
NATHANIEL TORBERSON
Tender detail
CN CHECK PAYMEN 231 $1800.08
Total tendered $1888.80
Total payment $1808.80
Trans date: 3/85/18 Time: 12:27:11
** THANK YOU FOR YOUR PAYMENT al,