DOCUMENTS Initial Application Da •
Application O 5c C T L 0 34
1 ' k I CU#
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.orglpermits
"A RECORDED SURVEY
Y MAP,
RECORDED DEED(OR OFFER TO PURCHASE)B SITE PLAN ARE REQUIRED WHEN
rSUBMITTING A LAND USE APPLICATION"
LANDOWNER: (TONA /HAA 8P00M6 Mailing Address: ) USS/ 5iiT#Wool) PR4
City: 7 U'ly4t' '4R6/y4 State:NW Zip.: 2752/contactNo: /I9-27I- /(YI Email: Jon4rooMee j*#i/ trim
APPLICANT': J 4Ai Mailing Address:
City: State:_Zip: Contact No: Email:
'Please fill out applicant information it different than landowner
CONTACT NAME APPLYING IN OFFICE: Rats faus Phone k
PROPERTY LOCATION:Subdivision V i cy<RI A HLot# �-'I: I 1 a Lot SSiizz�e': , ‘L'Af-LfM/AES
State Road# I CC S State Road Name: SMITH Ivo on �Pyt,�( ,, Map Bookoo8 Page:09C6 7 4 / l
Parcel: U %\ ego 53 6l 01 o`S]s 7 PIN: l�["�Ar-.✓/�yyy3---����A- 3(J 3 D • et y.
Zonings Stood Zone: (C- Watershed': I v Deed Book 8 Pager-1Wp81Power 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(wlwo 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_k 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
❑ Manufactured Home: SW_DW TW(Size x )#Bedrooms:_Garage: (site built?_)Deck: (site built?_)
❑ Duplex.(Size x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use: Hours of Operation: #Employees:)10 _
` LiIQ
Addition/Accessory/Othec(Size 2 L/ �l p° use. /9,01/1/9,01/1 /m
E GRobND oot Closets in addition?(_)yes (_)no
Water Supply: .soCounty 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?( )yes (_)no
Does the property contain any easements whether underground or ov�erhead(_)yes ( )no ,,/
Structures(existing or proposed):Single family dwellings: 1 Qij / Manufactured Homes: Other(specfy): y.
Sf0 Pub
Required Residential Property tine Setbacks: Comments:
Front Minimum Actual
Rear - arys-
Closest Side I ab
____-----
SideslreeUcorner lot
L_---____—_
Nearest Building
on same lot
Residential Lend Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: !/ 5 / 01 /v t Tb' RI‘// T
O/V7a J/if4YETrE , R/Grtr PNrc VicT°k/A n/« s b�
R/C1f 7 CHT' 7Yif" S 70i(f, , /Cfl 'fr7° s/h,7//hA eV,
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• tatements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
ignature o nen 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 is employees are 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"
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Residential Land Use Application Page 2 of 2 03/11
SUBJECT PROPERTY IS___ IS NOT . LOCATED IN A SPECIAL FLOOD HAZARD AREA AS DESIGNATED ON FEDERAL
EMERGENCY MANAGEMENT AGENCY (F.E.MA) FLOOD INSURANCE RATE MAP
NUMBER 3720066200,1 ZONE_X
VICTORIA HILLS SUED.
PB 2005, PG 655
LOT 158
LOT 157
EIP S 13'49'26 E 86.33' EIP
4 — O
B Y
v
(6
5 F 7003
i
li - '77
DR
SHED
NO FOUNDATION
28.51'
SITE eV
MINDY MAP\ 1.38 10.1
ri r
N.T.S. —� 1.53'
CHAIN LINK FENCE . `
3.16'
N
N • N
P 1 LOT 172 qR
MI . 26,079 S.F. S o
i0 11426 f<.. A
.
Ku
LOT 171 Z I �•f 3ECK HICH N
4a X 7,2 42• 18.07 S LOT 173
Proposed 2411 a -
19.58' a 5.2 a P18.2'
round above ground al 302. 6.5'•
y4•
pool location. bt ONE STORY •ry
MT FRAME 1 A/C 2.61'
7.5',... 0 �--
24$ n 12.3'' 2.90gra AD! LINK
I
2' 2010.1' FENCE
I 1
BUILDING SETBACKS: I CONC. n-' PORCH THERE IS A 10' UTILITY EASEMENT
FRONT 35' I DRIVE I LOCATED ALONG THE R/W AT THE
SIDE 10' 1 j in FROM OF EACH LOT
REAR 25' 1 r4
CORNER SIDE 20' ; Ica
ELECT.
1 i
PHONE
3 BOK
ESP 1 1 EIP 4 EIP
895.10' TO A POINT WHERE SMITHWOOD DR L= 73.66' N 1349'26' W 30.00'
BEGINS TO CURVE INTO TYLERSTONE DR R= 1163.32' GRAPH/: BCAi,g
CH= 73.65' b 0 40
N 11'00'55" W
SMITHWOOD DRIVE
50' PUBLIC R/W ( IN FEET )
VICTORIA HILLS 1 inch = 40 It
SUBDIVISION FIELD CLOSURE= 1; 14,861
vmO
'C FOR RECORDING INFORMATION FOUND v nano ma FH w sacs
PHASE 5 SO" ,.o`N Wean TO Nff NCO OWN w Nr l MON MANE n POMP CNE
A TALEWWI Nmrtaum IV Arw No SCOM*1E WS181001.24TWS WM>wr
LOT 172 BLOCK NIN U, 4 CN WOW NATY,r CA cern"NC
CS. CATCH SAW Wa FLAW)OO SWOON
RECORDED IN PLAT BOOK 2003 PAGE 477-475, HARNETT COUNTY, N.C.
I
HARNETT COUNTY HEALTH DEPARTMENT 16322
HTEe 3- b"-�19r ENVIRONMENTAL HEALTH SECTION
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OPERATIONS PERMIT�MI
Name: (owner) SA..¢ i�
. �wcF/=— New Installation B'Septic Tank
Property Location: SR# /07, O Repairs rification Line
Subdivision lit Lot# /74
pp Tax ID # Quadrant#
Contractor: Key Registration#
Basement with Plumbing: O Garage: Pr-
Water Supply: O Welluhlic 7 Community IA"
Distance From Well: 5'0 ft.
Following are the specifications for the sewage disposal system on above captioned property.
Type of system: Et'Conventional O Other
Size of tank: Septic Tank: /000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches I of each ditch 4100 ft. ditches ,7 ft. ditches 'i?G in.
French Drain Required: Linear feet
Date: /0 /1,74°7 /'
Inspected by fl/._/e I
PERMIT NO. /9 7� L C Environmental Health Specialist
i
1,'f'
•
IA a.Y-
D
ll
NAME: J 4r4THAN 8100A11 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 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.$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.
�tEnvironmental Health Existing Tank Inspections Code 800
/J�• 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 UDS OFF OF SEPTIC TANK
• Alter 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 I Innovative l—} Conventional {_I Any
{ I Alternative { Other
The applicant shall otify the I. al health department up,n sub ittal of this application if any of the following apply to the property in
question. If the a wer is"yes" applicant MUST A 'ACH S I PPORTING DOCUMENTATION:
_)YES { NO Does the site contain any urisdiction. Wetlands? A
}YES { I NO Do y,u plan to have an i . ions i.n now or in the future?
)YES { } NO Does r will the build' g contain any. .-is?Please explain.
{ DYES • }NO Are t -re any existi 1 wells,springs, .terlines or Wastewater Systems o this pro•erty?
{ }YES { }NO Is any wastewater going to be generate' on the site other than domestics, age?
l }YES l—} NO Is the -ite subject o approval by any of -r Public Agency?
{_ YES { I NO Are[hire any E- .ements or Right of Wa son this property?
{ } e_: {_} NO Does t - site c. lain any existing water, bible,phone or underground -lectric lines?
If yes p 'ase •?II No Cuts at 800-632-494• to locate the lines. This' a free service.
I Have Read This Application And Corti y That The Information Provided erein Is True,Compl e And Correct. Autho . ounty And
State Officials Are Granted Right Of Entry To Conduct Necessary Inspectio To Determine Co. pliance With Applicable Laws And Rules.
I Understand That I Am Solely Responsible For The Proper Identification And L •ling Of Properly Lines And Corners And Making
The Si .ecessible So That A C mplete Site Evaluation Can Be Performed.
u. ' OWNER ROWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) X DATE
10/10