DOCUMENTS Initial Application Date-LA l) I I Application t ) 2 U--5 +� / e S
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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.harnett.org/permits
^ARECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&811E PLAN ARE REQUIRED WHEN$USMI111NG A LAND USE APPLICATION"
yy tun 11 N�ll RJ.
LANDOWNER: If[ U n (w aM �lanc) q�d Qertpuq lon)Maiing Address: ZS4 h71tqr
City: QAt-fort) State: 11/41C zip. contact No: )ID -yYY-YIR Email: ShAun(+Qre(Wonlirvry{ti,)nr.rn.-1
APPLICANT': Mailing Address:
City: State: Zip: Contact No: Email:
'Please fill out applicant Information If diff went men landowner 1
CONTACT NAME APPLYING IN OFFICE: Sll qua Gaffhler
Phone 91u -9J'd7 - YI7Z
PROPERTY LOCATION:Subdivision: Sum'.'er 1,n Lot t: ?J' Lot Size: - it
State Road// 110 State Road Name: pe441r PuI L04e Map Book&Pagec&4t / 3-3Y
Parcel: OS q sly? 0054 s 3 �n PIN: 9s l0'7-$ V — `6-2 '.-3 • OCX-
Zoning:RA-�/"Flood Zone* x Watershed: ti-1"-Deed Book&Page: 3499 / 3i9 Power Company: (re n-fraI LM(
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: 3
60 3.)# y Z.S mono*.
• RFD:(Size x Bedrooms: t Bathe:_Basement(wMro bath):_Garage:_Deck:_Crawl Space:_Slab:_Slab:_
(Is the bonus room finished?(__)yes (___)no w/a closet?(_J yes (__)no(it yes add In with it bedrooms)
O Mod:(Size sift Bedrooma_p Baths_Basement(wMro bath)_Garage:_Site Built Deck:_ On Frame_Off Frame
(Is the second floor finished?( )yes Lj no My other site built additions?(_i yes (J no
O Manufactured Home:_SW_DW_TW(Size x I t Bedrooms:_Garage: (site built?__)Deck:_(68e built?_)
O Duplex:(Size_x )No.Buildings: No.Bedrooms Per Unit:
O Home Occupation:t Rooms: Use: Hours of Operation: //Employees:_
O Addition/Accessory/Other:(Size x )ties: Closets in addition?Lj yes U no
Water Supply: County _Existing Well _New Well(tot dwellings using well )*Must hays operable water before Nal
Sewage Supply: J New Septic Tank(Complete Checklist) _Existing Septic Tank(Complete Checklls0 _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?(J yesJ.)no
Does the property contain any easements whether underground or overhead U yes (J no
Structures(existing or proposed):Single family dwellings: J Manufactured Homes: Other(specify):
proPevel
Required Residential Properly Line Setbacks: Comments:
Front Minimum 35 Actual 3$.
Rear 2S Ff7r
Closest Side to 22 '
Sldestreet/comer lot
Nearest Building
on same lot
001 mamma r:flMTINI IPA flit RAMC
lbiejo
SPECIFIC DIRECTIONS TO THE PROPERTY FROM UWNOTON: ft z7 i " On r n
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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 foregoing statements are cur and correct to the best of my knowledge. Permit subject to revocation it false information is provided.
4104
Signature of Owner or Owner's Agent Date
"'it la the ownerhpploants 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,a The county or Its employees are not responsible for any
Incorrect or missing information that is contained within these applications.***
"This application expires S months from the Initial data it permit have not been Issued"
NAIVE: PfecUlon (odor, Home} i I?eAauq#Isar APPLICATION it:
*This application to be filled out when applying for a septic system inspection.'
Counts 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 8
Environmental Health New Seaga SvateruCode 800
• NI properly 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,#5.00 return trio fee may be Incurred
for failure to uncover outlet lid,mark house corners and crawly lines. etc. once lot continued 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 reouest.
• Use Click2Gov or IVR to verify results. Once approved,proceed to Central Permitting for permits.
Environmental Health Existlna 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 Ed back In Mlles (Unless inspection is for a septic tank in a mobile home park)
• DO NOT LEAVE UDS OFF OF SEPf1 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.
If applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference,must choose one.
[_1 Accepted [_) Innovative (KI Conventional 1_1 Any
{_) 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 (X)NO Does the site contain any Jurisdictional Wetlands?
1_IVES [ k) NO Do you plan to have an irtjpatinn cvsterg now or in the future?
1_)YES di 1 NO Does or will the building contain any dmign?Please explain.
(_DYES
(±)NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
l_]YES { Al NO Is any wastewater going to be generated on the site other than domestic sewage?
{_]YES 4_1 NO Is the site subject to approval by any other Public Agency?
{_IVES Ln NO Are there any Easements or Right of Ways on this property?
{_)YES (XI 1 NO Does the site contain any existing water,cable,phone or underground electric lines?
If yes please call No Cuts at 800-6324949 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 Authorised 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 AR Property Lines And Corners And Making
The Site Accessible SotA Cottite Evaluation Can Be Performed.
PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
THIS MAP IS NOT INTENDED FOR \ 26 / te
RECORDATION,SALES,CONVEYANCES l--
ORTOBEATTACHEDTOADEEDASANR=50.00' PB 2010,PG 411EXHIBITL=32.70'CHORD=N 39°06'44"E FRR 56A 7 eRM-
CH.LENGTH=32.12' ERB /Q'Sro$d0j0'E
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L=39"24' ��
CHORD ES36°13'39"W 4.1' A
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CH.LENGTH=25.94' V
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R=325.00' y� e PB 2017,PG 338
L=118.34'
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4 oA aS computed-byORFO.met6od. n 523°2923"W ti�
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2.All Distances Are Ground Disterkes. S67°13'57"E c
3.Property is Subject to all Easements of Record. ERB 53.63' ERa �52t 4 QQ
4.Adjoining P oµ,ry Information Per Hanlon County 449 Q
Tax Records. Ea' 26.43'S Em
5.This plot plan was drawn from a physical survey S 22°24'16"W
6.Property is zoned RA-20M. / -rSoil, FRB R=205.00' Y
/ \w L=36.05' A
$ CHORD=S 27°26'35"W
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CH.LENGTH=36.00"
ERR
0 60 120 leo PLOT PLAN FOR:
a ow i PRECISION CUSTOM HOMES AND RENOVATIONS,LLC
aaapunutittt SITEADDRESS:.JIBBEAUTIFULLANE
NORTHCAROLINA Se. CARO/ kba COUNTYOF: HARNETT
HARNETT COUNTY c1--et•••••,��1/ !�� TOWNSHIP OF:JOHNSONVILLE
I certify that this plat was drawn under my supervision from .� O ••••t.$$/D •9 ..
a physical survey.This map does not conform to Gs 47-30 as . �:•pOF tiy" DATE: 4/920178
amended and is not intended for recordation,nor should a _ l i- SEAL , 1 _ SCALE: 1"=60'
copy of this map he enechedmadeed asan exhbitmbe = $. F.
TERRY C. FAIRCLOTH,PLS
recorded per GS 89C-26. �t7 1-5185 �:
�J 2017 FALLOW RUN
/� �%Tf3'r�SUR.. G>': FAYETTEVILLE,NC 28312
•,Rr Fp\Q'�.�� PHONE#:(910)494-7444
Terry C.F loth License No:L- t�tttttt nttt11. EMAIL: faircfothsurveying®yahoo.com
WEBSITE:terrycfairclothpls.com
SOUTHEASTERN SOIL& ENVIRONMENTAL ASSOC., INC.
PROPOSED SUBSURFACE WASTE DISPOSAL SYSTEM DETAIL SHEET
SUBDIVISIONh.., r.. v " 1 y-,, LOT a71ET (/. ,;ic *e i¢1/4w, n.- /tY
INITIAL SYSTEM APPROVED25%RECUCTION (j+e l., REPAIR' }-1p vec) 15 /. 12% Le 1 c 4
DISTRIBUTION: tie f‘C,1DISTRIBUTION SC 1
BENCHMARK: 100.0 LOCATION r=! 1 ' ; 1_I"_
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Na BEDROOMS: H /LIAR O. Q' U 1'0 i r
LINE FLAG COLOR ELEVATION LENGTH
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TYPICAL PROFILE THERE SHALL BE NO GRADING
O '9 O L S e(i 'i (" ' CUTTING LOGGING OR OTHER SOIL
l o DISTURBANCE IN SEPTIC AREA
ANY DISTU RBANCEMAY CAUSE A SITE
TO BECOME UNSUITABLE
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HARNETT COUNTY CASH RECEIPTS
eaa CUSTOMER RECEIPT aa+
Oper: JBROCK Type: CP Drawer: 1
Date: 4/11/18 52 Receipt no: 310240
Year Number Amount
2818 58043775
91749 TECH 2
LILLINGTON, NC 27546
B4 BP - ENV HEALTH FEES
s750.08
NEN TANK
PRECISION CUSTOM
Tender detail
CK CHECK PAYSEN 4797 $750.80
50.00
Total tendered $750.08
Total payment
Trans date: 4/11/10 Time: 11:32:10
** THANK YOU FOR YOUR PAYMENT **