DOCUMENTS Initial Application Date: r I3 J) j? Application itt%.53214-1S44
.5C L • • I I
Cu#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Llllington,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 USEAPPLICATION**
LANDOWNER: ' 0u W4~JJ Mailing Address: ('h 0 Th4rtin 9 ]vel 121
City: Q't nn q State:at zip:2833Y Contact No: 9/`7-Goi-13/2 Email: WA 2G U G� /JC.2¢, COM
APPLICANT•::L 1 jJ^ r 10 Mailing Address: L4-1° �r(/ iIU✓f rem^
City OA no J state:WC Zip:1933 I"Contact No: 9/9-60/1-13 Email: WA2Go c)NC, 2P. Cgy)
•Please fill out applicant information if different than landomer
CONTACT NAME APPLYING IN OFFICE: LO LA ✓ "1 ri0 Phone# 67ry — Cib • - ' 3ly-
PROPERTY LOCATION:Subdivision: ✓ Lot#: W Lot
ySizre::Salt-i 71�
State Road* ra3 State
r``Road Name: Tlir\I�S(�O f p Map Book&Page:PC* 1 /44 "✓
Parcel: En I S69 bC V 1"--fl
PIN: LSVIf1>• 6I -Sn ( a ecj
Zoning Rif] 714 Flood Zoned Watershed: w l Deed Book&Page:3`'A 13/ 3 7 7Power Company:
*New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Size x I*Bedrooms:_it Baths:_Basement(wA o 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)
❑ 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
❑ 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:_
0 Addition/Accessory/Other:(Size /y x //) )Use: e 5 p h t..1 r7 D l ✓N. OC"room Closets in addition?(_)yes (A)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) Y 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 overheady (_J yes ( )no
Structures(existing or proposed):Single family dwellings: ULY. 1 Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum ^ Actua.r-.
Rear _14.45 T
Closest Side r^—
SideslreeUcornerlot
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 m 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 s ents ar ccurate an correct to the best of my knowledge. Permit e to revocation if false information is provided.v
s1 1
Signet of Owner or nee.Agent Data
""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 issued"
Residential Land Use Application Page 2 of 2 D3/11
NAME: APPLICATION#:
*This application to be Idled 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 I 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 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 ExIstlnc 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
• 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 constmct please indicate desired system type(s): can be ranked in order of preference,must choose one.
I—I Accepted (_) Innovative i } Conventional {_} 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 {_} NO Does the site contain any Jurisdictional Wetlands?
{_}YES {_} NO Do you plan to have an itrieation system now or in the future?
{_}YES I } NO Does or will the building contain any drains?Please explain.
}YES I—1 NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
{_)YES {_)NO Is any wastewater going to be generated on the site other than domestic sewage?
{_}YES i_} NO Is the site subject to approval by any other Public Agency?
{_}YES { j NO Are there any Easements or Right of Ways on this property?
(_}YES (_} 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 Access le So That A Complete Site Evaluation Can Be Performed.
7-3- /
PROPER OWNERS ) N LEG AL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
_
SR 1)p—__ w
Rp AD ,_
s mit,. E °TON ROA —� /
��__ mit,. o
0
- s
o
'z
x
o TO
re
mM
Q at P°th ¢?
/ r~
11z
es
h.
afla
wwx 1 i C
9W 0110304
.---- 91tl1510
�1} lVAOtlddtl NYid 3115
.57
na
z
R
ESR -71 ESR 3
NPw
0
3 x
L\0 15 R WIDE PPiH ry n
F m
Pn pay 4 13
• 0
+ -
Cr::::, m `•,' 0 00
ri 1... A eT•r`' • r
5.04 ACRES G1` 19+ _ d O
_oo� I o
+
I DEED REFERENCE
BOOK 3493- PAGE 377
WP RU P0 13 o
.
H BT00'' w
MAP FOR
DANIELS OFF RD NC KIMBERLY STEWART CAPEHART
LOUIS PETER WARCO JR
COUNTY
GROVE HARNETT
30 0 00 60 STATE: NORTH CAROLINA DATE:
SCALE: 1 IN 61
GRAPHIC SCALE ZONE: TAX PARCEL: NC F9N 1509-31-9772.000
HARNETT COUNT CAS' RECEIPTS
a0* CUSTBER RECEIPT xxw
Goer: JHROCK 'yne: CP Drawer: I
Date: 7,63/16 52 Receipt no: 2466
Year Humber i oust
c016 56644411
91749 TECH 2
LILLINGTON, NC 27546
H4 EP - ENV HEALTH FEES,
4160.06
EXT TANK
WARGO CONST
Tender detail
CK CHECK PAWN 2688 6100.80
Total tendered 4166.69
Total payment 4166.66
Trans date: 7/63/16 Tine: 13:03:36
** THANK YOU FOR YOUR PAYKEHT **