DOCUMENTS •
Initial Application Date: 7�Z �K Application# �^"— l I n�,
CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27566 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.hametl.orglpermits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING AnnLAND USE APPLICATION"
LANDOWNER'iP_ki e'l�a1 'w Pe-rile, i1 metes, nN1kZMailingAddress: .S64-C Lkr.ctc.r-t Qs91s} CU Li- a75
City: cu c[ ect UcLrinq State:' C- Zip:21-at Contact No': Nei 39£e-13a Email':,e IGatI.Fr"�i,c-(ITof I.Ca ILr
APPLICANT': ice\JJ.r xos.o 4101,P L Mailing Address:_<61- U-'e LC'1.D✓. 2r.1 LY pa.
Cityn V.y-.r „q StateAIL. ZiPA706 Contact No: 4I41'39561- I37LEmail:a te. . r• e , "qi I- crlti,
teasefill tap` nt Information',different than landowner l /
CONTACT NAME APPLYING IN OFFICE:c a.rra a Ln fUs1\FL�Z /y Phone# RI Pt'39T �' I32 '
PROPERTY LOCATION:Subdivision: ./1 D4 I t-e sS 1 -,r//� Lot#: I Lot Saze/h S�./-�
State Road^#1 k I a Stltaatteee Road Name: % l�/�C&n tithe(Q Y 1/�' Map Book
&page 'f 12_3J3
Parcel: (9 c C)L0 3 �L L Js—�I I b PIN: LJIOF3c1 c 1 - fv ss t 'vcO
ZoningSAIV -Flood Zonel��L_Watershed/ Deed Book&Page://b"7 4S ower 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)
U Mod:(Size_x )#Bedrooms_If Baths_Basement(w/wo bath)_Garage'._Site Built Deck:_ On Frame Off Frame_
(Is the second floor finished?( )yes (_)no My other site built additions?( )yes (_)no
❑ Manufactured Home'._SW_DW TW(Size x )#Bedrooms:_Garage: (site built?_)Deck: (site built?_)
O Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:*Rooms: Use: Hours of Operation: *Employees:
Addition/Accessory/Other:(Size 4 1{ x I.Y)use: `-'l zUI -ifClosets in addition?(_)yes (_)no
Water Supply: J/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?( )yes (_ no
Does the property contain any easements whether underground oroverhead(_3s (_)no
Structures(existing or proposed):Single family dwellings: ✓ Manufactured Homes: Other(spedfy):
Required Residential Property Line Setbacks: Comments:
Front Minimum.� S Actual �
_
Rear _ 1
Closest Side 11::: `-'f-b,a
Sidestreet/corner lot II hh 1 n ���,l,^1```���xxx--�� ��,�-s^, 1
Nearest Building Irl_)
on same lot �IJJ
Residential Land Use Application Page 1 of2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
If permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the spedfications of plans submitted.
I hereby state that fore inn tatements are accur to and correct to the best of my knowledge. Permit subject revocation if false information is provided.
z2 7/i 11/7
Signature of Owner or er's Agent ate
•
•
"9t is the owner/applicants responsibility to provide the countyrwlth any applicable information about the sttbject 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 0a/11
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F ;NETT COUNTY HEALTH DEPART 'ENT
HTE o3-5-Waite ENVIRONMENTAL HEALTH SECTION 16426
OPERATIONS PERMIT
Name: (owner) /circr,Aeo Arid' In New Installation 2ISeptic Tank
Property Location: SR# //01 Cc//erMiy,..,p O Repairs Ni/trification Line
Subdivision Lot#
Tax ID IF Quadrant#
Contractor: E7Ia.✓s✓3 Registration#
Basement with Plumbing: O Garage: O
Water Supply: O Well 2<blic O Community
Distance From Well: rad ft.
Following are the specifications for the sewage disposal system on above�captio/ned property.
Type of system: Conventional Q OtherR.,A arwe-04.rti�/io
Size of tank: Septic Tank:/6YjA gallons Pump Tank: /0_)_9(L' gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches .S of each ditch /IC ft. ditches 3 ft. ditches / nr.
French Drain Required: Linear feet
Date: //-/D -03
Inspected b,reo i . e
icv
PERMIT NO. /194, Z nvtronmental Health Specialist
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NAME: APPLICATION k:
*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 aVfor 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.
y/ Environmental Health Existing Tank Inspections Code 800
1 _ • 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 8 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 constntq please indicate desired system type(s): can be ranked in order of preference,must choose one.
{_} Accepted I ) Innovative 1—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 Wig ficwsji s cm now or in the future?
{ )YES { }NO Does or will the building contain any drains?Please explain.
LIVES II 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 {_} NO Is the site subject to approval by any other Public Agency?
{_}YES { I NO Arc there any Easements or Right of Ways on this property?
{ }YES 1—) 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 So That A complete Site Evaluation Can Be Performed.
PROPERTY OWNERS R OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
HA***T CSELrS
UTOMER RECEIPT
Open: CORCCK Type: CP Drawer: 1
Date: 7/12/1& 52 Receipt no: 16535
Year Numter Amount
2016 55044474
5675 CHRISTIAN LIGHT RHS
FUGUAY-VARINA, NC_27526
04 PV - ENV HEALTH FEE
U00.'0
EXT TANK
AJILES EELIGIADO
render deta'
LG CREDIT CARD 4109.0e
Total tendered 5100.x0
Total payment
Trans date: 7/i2/10. Time: 15:5i:07
** THANK YOU FOR POOR PFYMERT a*