DOCUMENTS Cc
Initial Application Date:SI t; i n O Application I S T ` I V
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 exl2 Fax:(910)893-2793 www.hametl.org/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWN,E/R: .,ZUsi t C&IZ J . (DtSN Mailing Address: y92/ TACt 4,106? 'a2
City:.e4LC th/{ State'. Mt Zip: 2Q/5 Contact No: Email:
KR1srn?Effie0QuuJN" cJ(Nn,t '/ ,/ OOP
APPLICANT•: Mailing Address: 53/y ryAM,T/�//
City: r/N/Pliel//t LE State://C Zip: t f3/I Contact No: 1109 243G910 Email: OO9uinn 92h�EovvicC(.ce
'Please fill out applicant information if different than landowner V
CONTACT NAME APPLYING IN OFFICE: Phone# ,/�
PROPERTY LOCATION:Subdivision: Sir NAQT 5 Crews Lot#: 1VT Lot Size:eII.'• (d DOa.c
State Road# 20,341 State Road Name: 91/4 1.4C-f( 122 Map Book&PageaD011 -Cc-Ito
Parcel: 12051,16 O//5 /�) I PIN: O�/6 "3%f' —nee 0 .006
Zoning:eq-20/Z Flood Zone: A.) Watershed: Al Deed Book&Page: 957e3 /QSf7- Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Size x 1#Bedrooms:_#Baths: Basemem(w/wo bath' _Garage: Deck Crawl Space'._Slab: Slab:_
(Is the bonus room finished?( )yes (_)no wl a closet?( )yes ( )no(if yes add in with#bedrooms)
AMod:(Size,Lx -11, )##Bedrooms I #BathsZ• Basement(w/wo bath)_Garage: _Site Built Deck: ✓ On Fier Off Frame ✓
(Is the second floor finished?(_)yes ( )no Any other site built additions?( )yes (_)no
❑ Manufactured Home: SW_DW_TW(Size x )1(Bedrooms:_Garage: (site built?_)Deck: (site built? )
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use: Hours of Operation: #Employees:
❑ Addition/Accessory/Other(Size_x_)Use: Closets in addition?( )yes (_)no
Water Supply: County . Existing Well New Well(#of dwellings using well )'Must have operable water before final
Sewage Supply: eco 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 (_)no
Does the property contain any easements whether underground or overh ad(_)yes (_)no
Structures(existing • .I.�. ...ingle family dwellings: Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum Actual
Rear
Closest Side
Sidestreet/corner lot
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
,LIN 11 o ,/%9 �//_
S/P,�_c1IFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: 2/O JO ELL/O2 /3g,o9E syo ' "•�ri��/e '/C C�/H�
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If permits are granted I agree conform to all ordi -•ces and laws of the 'ate of North Carolina regulating such work and the specifications of plans submitted.
I hereby state emen ar-
re
and correct to the• of my knowledge. Permit subject to vocation if false information is provided.
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Sign- - • ner or • .rs • r-nt 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 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 Issuer
Residential Land Use Application Page 2 of 2 03/11
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NAME: /24157-09(15/2 to ass - "_ INcen' APPLICATION*I:
*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
W 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 SvstemCode 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 it 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 UDS OFF OF SEPTIC TANK
• Atter 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 {_} Innovative IXI Conventional 1_1 Any
(_) Alternative I—I 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?
(_)YES (JO NO Do you plan to have an raj onsystem now or in the future?
)YES (V I NO Does or will the building contain any drains?Please explain.
( IVES ILI NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
(_)YES (L) NO Is any wastewater going to be generated on the site other than domestic sewage?
i_IYES (SL)NO Is the site subject to approval by any other Public Agency?
{ }YES (A) NO Are there any Easements or Right of Ways on this property?
( )YES 1)4) 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 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 1 Am Solel 'sponsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The�t ccessib -• ' :"OW Site Evaluation Can Be Performed.
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'' / RS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
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2004010831
UNTY CSH
EIPTS
HA*** COSIIGNER REC
CEIPT4* *
Omer: IBROCN Ree: CP no::rawer: 1
Date: 5/29/18 52 Amount
Year Humber
2018 50044118
91749 TECH 2
LILLINGTON, NC 27ENE, HEFLiN FEES
84 6750.00
NEN TANK
K 'MINN-WINGER
lender detail 1750.00
CG CREDIT CARD f756.00
Total tendered 4750.30
Total payment
Trans date: 5/29/18 Time: 'WC W36pil
Ya THANK YOU FOR YOUR PATNENT *4