DOCUMENTS Initial Application Date: LA\at...0 p Application# I,3 S 0-1 ?S-7
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPUCATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893.7525 ext:2 Fax:(910)893-2793 www.hamett.org/permits
^A RECORDED SU MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
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LANDOWNER:(�� Tint rip s Pro INA-leg Mailing Address: PO LEcalc 8 75 }+ \
City:ac oad 1.4_1 ti State NZip %contact No: Email:SOU PYh Lo n Cr.02-1-12-)
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APPLICANT: 5Q Me- Mailing Address:
City: State:_Zip: Contact No: Email:
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CONTACT NAME APPLYING IN OFFICE: IISI 2.NJ t r /-1 O t714 a `` Phone# 9 1 CV 4 0 6 — 4 0 6
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PROPERTY LOCATION:Subdivision: I T(0 3 LQ W'4 PNCQ teat cul Lot#: T Lot Size' r 1 9
State Road# I a.1 a1 State Road Name:
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'NeN&Wdures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROP SED USE:
Monolithic
SFD:(Size 50 x co )#Bedrooms:3#Baths: Basement(wAvo bath)_Garage:✓ Deck:_Crawl Space:✓ Slab:_Slab:_
(Is the bonus room finished?U yes ( )no w/a closet?( 1 yes ( 1 no(if yes add in with*bedrooms)
❑ Mod:(Size_x )#Bedrooms_#Baths_Basement(whim bath)_Garage:_Site Built Deck:_ On Frame_Off Frame_
(Is the second floor finished?U yes U no Any other site built additions?(j yes (_1 no
❑ Manufactured Home:_SW_DW TW(Size x )it Bedrooms: Garage: (site built?_ )Deck: (site built? 1
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use:_ Hours of Operation: #Employees:
❑ Addition/Accessory/Other(Size x 1 Use: Closets in addition?Li yes (i no
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 tract of land,own land that contains a manufactured home within five hundred feet(500')of tract listed above?(j yes ( )no
Does the property contain any easements whether underground or overhead( )yes ( 1 no
SWctures(existing orioposed)Single family dwellings: Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum as Actual TO
Rear 3S 34-0
Closest Side � 15 �a
Sidesbeet/comer lot
Nearest Building
on same lot
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APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM(� LILLIN\GTON: 4-al /V — I `*ICC: C% 4. \ a I', P-011 y
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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 ate accurate and re 1 e best of my knowledge. Permit subj tore cation if false information is provided.
rDate
Signature of Owner or Owners Agent Date
"It is the owneriapplicants 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 are not responsible for any
incorrect or missing Information that is contained within these application."'
"This application expires 6 months from the initial date If permits have not been Issued"
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SITE PLAN APPROVAL
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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 t CONFIRMATION#
0 Environmental Health New Septic SystemCode 800
• All properly irons must be made visible. Place "pink property flags" on each corner iron of lot. All property
lines must be dearly 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 trio 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
• 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 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.
{_) Accepted j_}Innovative {XI Conventional (_I 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 14.1 NO Does the site contain any Jurisdictional Wetlands?
(_)YES ( .I NO Do you plan to have an imieatinn system now or in the future?
{_}YES O NO Does or will the building contain any drains?Please explain.
I_}YES {4l NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
{_)YES {4}NO Is any wastewater going to be generated on the site other than domestic sewage?
{_IVES NO Is the site subject to approval by any other Public Agency?
{_}YES IL) NO Are there any Easements or Right of Ways on this property?
{_}YES {Vit)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 C 1 te-ire v I at on Oe Be Performed.
PROPERTY OWNERS OR OWNER GAL REPRESENTATIVE SIGNATURE(REQUIRED) ATE
10/10
HARNETT COUNTY CASH RECEIPTS
mam CUSTOMER RECEIPT aaa
Oper: JBROCK Type: CP Drawer: 1
Date: 4/26/18 52 Receipt no: 332482
Year Number Amount
2818 50043879
1463 LAWRENCE RD
BROADWAY, NC 27505
B4 BP - ENV HEALTH FEES
$750.00
NEW TANK
THOMAS PRO
Tender detail
CK CHECK PAYMEN 4925 $750.00
Total tendered $758.00
Total payment 1750.88
Trans date: 4/26/18 Time: 10:24:41
** THANK YOU FOR YOUR PAYMENT as