HomeMy WebLinkAboutDOCUMENTS SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
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If permits are granted I agree to conform to all ordinances and laws f the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing statements are accurate and correc the best of my knowledge. Permit subject to revocation if false information is provided.
Signature Owne 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 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"
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Residential Land Use Application Page 2 of 2 03111
NAME: f d)/20- 1-4Q5/IAL/4 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 System Code 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 Existing Tank Inspections Code 800
in • 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 {_} Innovative {_} Conventional (_) Any
{_} Alternative {_) Other
The alplicant shall notify the local health de. rt ent upon submittal of this application if any of the following apply to the property in
question. If the answer is"yes",applicant , US ATTACH SUPPORTING DOCUMENTATION:
(_}Y S {_} NO Does the site ontain ny Jurisdictional Wetlands?
{_}Y S {_} NO Do you pla to have:n irrigation system now or in the future?
{_}Y. {_} NO Does or 'll the hulloing contain any drains?Please explain.
{_}Y: (_)NO Are the - any existi ._ wells,springs, waterlines or Wastewater stems on th s property?
(_}Y . {_} NO Is any wastewater go ng to be generated on the site other tha domestic sewag ?
{_}YE` {_) NO Is t site subject to .proval by any other Public Agency?
{_}YES {_) NO Ar• there any Easeme is or Right of Ways on this pro.• ?
{_)YES (_I NO 'does the site contain an existing water,cable,pho or underground electric li -s?
If yes please call No Cuts 't 800-632-4949 to I. ate the lines. This is a free sery •e.
I Have Read This • . cation And Certify That The Inform. '.n Provi' •. erein Is True,Complete And Correct. uthorized Co y And
State Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applica• -. • s 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 hpI Ai mple to Evaluation Can Be Performed.
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PR.1 j,9'TY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
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Nov 14 2017 05:07PM Stoner Electric, Inc 919 7185827 page 1
Application#
Harnett County Central Permitting
PC Box 65 Lillington, NC 27546 - Ph:910-893-7525 - Fx-910-693-2793 - www.harnettorg/permits
Certification of Work Performed By Owner/Contractor
(Individual Trade Application) (
9/0
Owner(s)o'Structure: "/L-4`t_, Phbne: -/Q
/0 ) -4-rf
Owner(s)Mailing Aadress: 7 ' 7i_ 1 Ian
Land Owner Name (s): 4 Phone:
Construction or Site Address: ) 4' 1 e.)0 Y-15LakeNI
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PIN# Parcel#
Job CostA 9 81-Z-Description of Work to be done h 57J( ,i ,c, -TU co
-QcZ37) dry i-b er�Qse-e
cane'nom A
Mechanical: New Un.t Wit Ductwork_ New Unit Without Ductwork Gas Piping Other_ \\
Electrical': 200 Amp t <200 Amp_Service Change Service Reconnect_ Other \�
For Progress Energy customers we need the premise numoer c J`
Plumbing: Water/Sewer Tap Number of Baths Water neater �I
Specific Directions to Job from Lillington: ofj
Vi / . '.
Subdivision: , `
mot#:
7.5-Ay.c
I etSet-P will provide the ('Ci9 labor on this structure. l
(Contractors Name) (Trade)
I am the building owner or my NC state license number is,2:3/.673 E , which entitles me to
perform such work on the above structure legally. All work shall comply with the State Building Code and all
other applicable State and local laws, ordinances and regulations.
/l .e • 5-)75X-e-,(' E12069e., • � /9 � � tf - g j-7
Contractor's Company Na a Telepho`
3 al Kis 'vE.5Q PI /tic eiz .6)4tn4Q(e0Or, -/.
Ad ess Email Address
License#
Structure Owner/Contractor Si nat
g .,1�' •411I��1 _ Dates/ - 19/f
By signing this application you affirm that you have obtained permission from the above listed [cense holder to
purchase permits on their behalf. If doing the work as owner you understand that you cannot rent. lease or sell
the listed property for 12 months after completion of the listed work.
*Company name, address, & phone must match Information on license