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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE #
ADDRESS
NAME OF MOBILE HOME PARK OR S/D Rrf>(g~ G4 b 23
NAME OF OWNER (IF DIFFEREN7) ► ~ - 5 ~~a c ~ ~ f
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If this system should malfunction, the owner is responsible for
any necessary repairs.
THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or
(2) the system should fail or malfunction, and/or
(3) the owner or tenant of the property changes, and/or
(4) after six months
BUILDING MUST BE 5' FROM ANY PAR'S O SEPTIC SYSTEM
DO NOT DRIVE OR PARK,014 SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature
Date
Specialist
Initial Application Date: A ~'s ~-zvaz
ppkaGon M
COUNTY O
F HARNM RESIDENTIAL LAND USE APPLICATION CU
Central Permitting 108 E. Front Sheet, VII on
NC 27548 Phone: (910) 893-7525/ Fax: (910) 893-2793 www.hamett.org
LANDOWNER: o ~ E~ f /9/r ~ A M"Ing Address: '4/
City: 'QAlr or State: V Zip: 22Home M: :==contact M:
APPLICANT': 64i¢t/!
Mailing Address: ~ . J .
City Stater 60
p z Q
n'aase rr ul aookwi nformation it different than landowner Zp. Home COntaCt / O ✓J
CONTACT NAME APPLYING IN OFFICE:
~ ~ Phone N /O - E Z2 -333 y
PROPERTY LOCATION: Subdivision: &l16& n/' S
-Lot M: 2 Lot Slze:~
State Road
State Road Name: Map ok3P~G Ti 11A
r BoA /
Parcel: ~ ! 7 2p5 -72
p PIN:
040
Zoning: ' Z~ry Fk)od Zons: Watershed: Boomp 7
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LiLLINGTON:
pRnPOSED USES (I-Jude Bonus room as a bedroom N d has a closet)
SFD (Siz,. _ _x_ # Bedrooms _ M Baths_ - Basement (wdwo bath) Gera - -10:
U ge Deck tab
(Size.___x`J M Bedrooms M Baths Basement (w/wo bath) Gar s -
Manufactured Home: _SW ~W a0 Site Bulk Deck ON Frame /OFF
_ Tw (Size X M Bedrooms 3 Garage /(sne built?
J Duplex No. Buildings
No. Bsdrooma/Urit Uedc~s bulk9~'
J Home Occupation M Rooms_____iUse
J Additton/Accessory/Other (Site x Hours Of Operation: ME-ploys"
Use
Closets In additionUY~ IJno
Water Supply: (4ounty U Wall (No. dwellings _J MUST ha" Sews Operable water before final
9e Supply: U New Septic Tank XOMIC lefe Afew rank Choc*Nsf) d'~ating Septic Tank
Property owner of this tract of land own land that contafra anufed ~-)^N Sswer
horns w/In flue hundr,
feet (500') of Tract iislad above?
Structures (existing or proposed): Single tamity (DYES
dwelpngs=Manulectured Homes Z
or (ep~fYl
Required Residentlai Property Ufa Setbbaac/ks:
Front Mlnfmum Actual / S
Pear 2 /
Gosost Side --Z6=
S destroet1corner lot
Nearest Building
ur Same lot
0
u 10 ~
it Comments:
It perm is are granted I agree to conform to alt ordinances and laws of the State of North Carolina repulaNng such work f l n
i HereZsfatetha egoing statements are accurate and correct to the best of m kr►owl and the specifications of plans submitted.
. Y edps. Permit stbject to revocatlon it false information is provided. Signs or Owner's Apertt
Dots
"Thls application explrss 8 months from tft InMaf daft M no permits have been Issued"
A RECORDED SURVEY MAP, RECORDED DEED (oft OFFER TO PURCNA$g) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
Please use Blue or Black Ink ONLY
*9"07
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SITE PLAN APPROVAL n
DISTRICT USE ~(J
NBEDROOMS
-7- _ 0 Zoning AdminIS for
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Hate IN
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