DOCUMENTS Initial Application Date 2-,I Q 1 118 Application# I 8.5 31013
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)693-7525 ext:2 Fax:(910)893-2793 www.hamett.org/permits
"A RECORDED�A� SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE
REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"'
LANDOWNER:IICCCG✓17 Qs-randLOarden Mailing Address:dn511 /) Q111.014 Dr rudeum. UOAe7n. .2.>s-k4
City: 6Lt4LAad/ ILJwIri4. ^State:A) Zip:)fl 1. ContacttNNoo':X414-.27s-4SL11--�Emmaaiill': bt oer�aynf 'Z o�.1I•L�
APPLICANT*: r II�u IWfeier\ Mailing Address: •a l(] i\o04l.s'r hi- brL• V
City: P1 aawnQar nc.. State.JU Zip.I7S-).Contact No:9l'1'.17S9V L Email:Q( r)tnk . 53Cd5Pu� I.Com
'Please Rn Pi
applice aton if different han landowner
c 0.M t- h �pta.•f
CONTACT NAME APPLYING IN OFFICE:p �1S Phone# `J
PROPERTY LOCATION:
Subdivision: 94a.-hart cSu•Foist U1 i�%/CC% Lot#: SI Lot Size: .7a.
State Road# I y 4 3 State Roadr-� Name: f\414 n S •C `f 1 - (M1ap Book 8 Page:r.7CaY/ -A 3
Parcel: bu b (pig Wl L0 y PIN'. �\ OI,�S-.�yJ� I - `I os s `Ot
Zoning:I1R b Flood Zone:X Watershed:-L�- Deed Book 8 Page:3 353 4 l`IPower Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Size x )#Bedrooms:_#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#bedrooms)
❑ Mod:(Size x )#Bedrooms_#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 (_)no
U Manufactured Home: SW_DW_TW(Size x )1*Bedrooms:_Garage: (site built? )Deck: (site built?_)
❑ Duplex:(Sizex )No.Buildings: No.Bedrooms Per Unit:
❑/ Home Occupation:#Rooms: Use: Flours of Operation: *Employees:
lie Addition/Accessory/Other:(Size I V x r°1)Use: `'/o•.yy... ,y Ram 1.3/%141A(11"Te 1.11(11"room Closets in addition?(_)yes (jerr
Iay-
Water Supply: County Existing Well New Well(#of dwellings using well )*Must have operable water before final
Sewage Supply: New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) County Sewer /
Does owner of this tact of land,own land that contains a manufactured home within five hundred feet(500')of tract listed above?( )yes (e'rw
Dees the property contain any easements whether underground or overhead( )yes (.no
Structures(existing or proposed):Single family dwellings: Manufactured Homes: _ Other(seedy):
Required Residential Property Line Setbacks: Comments:
Front Minimum Actual
Rear 02 S c c
Closest Side 10 lQ3
Sidesireeucarner 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:
•
If 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 that foregoin is are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
• 3 > i — is'
of ner or Owner's Agent 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 empldyees are not r6sponsible tot 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 03111
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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 1 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.
• 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 Existlna Tank Inspections Code 800
kr
• 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 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.
I_ Accepted (_} Innovative ( j Conventional (_I Any
( Alternative (_) Other _
The .,.plicant shall notify the local h-. th departm-.t upon submittal of this application if any of the following a.. o the property in
quest in. If the answer is"yes",al.titan MUST A TACH SUPPORTING DOCUMENTATION:
I_1 IS (_)NO Doe-the site contain any lu .dictional Wetlands?
(_I S (_l NO D. you plan to have an Tri; ,_ I- now or in the future?
( I :S fi NO roes or will the building contai any drains?Please explain.
( iT . ( I NO 're there any existing wells,spri :s,waterlines or Wastewater Systems on t s property?
I_)YE' j }NO Is any wastewater going to be gene ited on the site other than domestic sew.ge?
( IVES I_i NO Is the site subject to approval by any . her Public Agency?
I_IYES f )NO Are there any Easements or Right of W. son this propen ' ,
{_IVES _} NO Does the site contain any existing water,cab e, . lite 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 .. cation 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 hat , Complete Site Evaluation Can Be Performed. —/
WI AV A 5'14 '11
1 PEATY O•�• 'r • •• OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
HARNETT COUNTY CASH RECEIPTS
*$$ CUSTOMER RECEIPT awe
Uper: TBROCK Type: CP Drawer: 1
Date: 3/21/18 52 Receipt no: 296146
Year Humber Amount
2818 58043613
54 MOONLIGHT DR
FUOUAY-VARINA HC 27526
B4 DP - ENV HEALTH FEES
$100.08
EXT TNAK
BARBARA WORDEN
Tender detail
CK CHECK PAYMEN 1074 $100.08
Total tendered $100.00
Total payment 4188.00
Trans date: 3/21/18 Time: 13:54:49
** THANK YOU FOR YOUR PAYMENT **