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LAND USE Initial Application Date: Z / - /1 Application # h / ✓ P Z" / 7 CU# COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION Central Permitting � 108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.harnett.orglpermits c LANDOWNER: f IWW%44 1-4nr \ n Am, crux Mailing r. %et 3.3( `j IQ - '1'10- 02gl f]Ll ;W City: ¶ i State:AL_ Zip: alSor Contact# 19 -1141X Email: APPLICANT': nnfMAwl 1 Pnn IN OAr..eY n Mailing Address: T h CR. of 3' 9 lq- - rm- ewer. City: ( Dqo \L,)e,,1 State:_ Zip: Q1S Contact # '119 -l'lo -0 91. Email: 'Please fill out applicant informhtion If different than landowner CONTACT NAME APPLYING IN OFFICE: c A Phone J 9 DJ PROPERTY LOCATION: S ubdivision: �6P #: ,f ! Lot Size: 7/ 71 State Road # 0/4 2 /State Road Name: t' /�; y 2/ / /� Ma BBoo / C �f Parcel: 1,3 h J q POpS -- -y'-�� PIN: 9 49° f — 6 / i Pte(/ Zoning:A 30 Flood Zone: Watershed; !1L-� Deed Book &Page: 20, ,61,i.i Power Company': *New structures with Progress Energy as service provider need to supply premise number from Progress Energy. SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: (DIA 9 D-1 - e- Troperl., l >x-4- On( INP1r DiA 4A1 1- SI4 vc' RJ, PROPOSED USE: Monolithic ❑ SFD: (Size _x_) # Bedrooms:_ # Baths:_ Basement(w/wo 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) ❑ 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 y.DW TW (Size - ]a x ,i ) # Bedrooms: Li 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 1, New Well (# of dwellings using well 1 ) '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 tr t listed above? (_) yes / �7 ( )no Structures (existing or proposed): Single family dwellings: Manufactured Homes: : / (/s /% Other (specify): Cy41" 5 yr v 3 Required Residential Property Line Setbacks: Comments: Comments: ' Front Minimum 3 Actual 2 Z Rear Z I Dal "- Closest Side fa _,aL- SldestreeVCornerlot J Nearest Building r 7 Z on same lot If permits are granted I agree to conform 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 statements are accurate and correct to the of my knowledge. Permit subject to revocation if false information is provided. CC i � . -I - 1 Signature of Owner or Owner's Agent Date "This application expires 6 months from the Initial date If permits have not been issued" A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION Residential Land Use Application Page 1 of 1 07/10 CRtAltS A auoua.... ...• 017 / / // 1 `/ N'/ //I/ ft IS A RECOMBINATION OF A PORTION OF AN EXISTING PARCEL OF LAND IN HARNETT' C RE hItEAKESPLS EXEMPT TIONSO HE HARNETT COUNTY SUBDIVI91 , 7/ 1 SITE PLAN kin p ROVAL �� DAT (/ USE DISTRICT I 1 { L -2607 :J . , 1 *BEDROOMS TOTAL AREA SURVEYED 2- / -- II n 86.5 ACRES ,,kg Zoning Administrator (AREAS INCLUDE PORTIONS OF AM AS T ue nale n.3'„:( m 1 ..�+� . ;2 h • © ` N Y ....,. � � oRO 5 = P A E D 1 E tk �� a — CAMERON — — — t „ ', 609/121 S69'03'50'E 925.10'T0. — NIP 680.91' NIP 244.19' '=;n I tC 2 i ,, CAME _ pc.F /2714 m c �, oi " � � R N bu " ;. 1 \ 50 ' REFERENC :{ = IRON , ': n. \ - fq - =� — — �\ 50.00' .0 ^„ Nip 50 n ' t :. I n m f. 2 �� e tit9 IT Al r l �� 4 4 1.39 AC. w 41. 1 n 4 A CAM ERON Y , f Asa: 429[66 PC. /2714 i 1N87 '09'16"W ' w C n� P v 30.00' A PORTION OF CAMERON PARCEL (4)2)9/7551RON 1299 //13 ^ , I O - EE D NOT T O BE CONSIOERE U(SEPARATE 30.00' Me. 96/3 var 1 - .AND NOT TO BE I , ,. g ( , r NSSITES. ::• 1 W >' :•' I - 88'88' 17'E ° RE C OMBINED AREA: 3.80 ACRES ,# ° y 32X;2 t , r R , 1 04:4 1 r +r - 1 CUTY • 1 Era tbm 1 924/625 1 iv N. t :r I N/F , I .} 2x6 N6g '43'gg p • 5 IP 466.00'70. NIP - 1/ O LD US 421 ° o s.eo 0 in )(H I se 3 4'se' = e'�° . ,7e p� 9R AC. nj p SR#l291 -60' R/W ' 2 .69 r PAVED — — (� — — l ° X 3.02 AC. `ni a ss N12'48'05'W — — _ 1 w 5.24' PK'S - r ye N/F 60.8 1 00' N1 J { ROUSE � N85'1•'53 554.34 160.87'30. - - - -- C2 '.1. I 1 I I N85'43 �� TIE: {ri 9 Q 1 1 CL AYTON I i � 1 "p' \ I 1 N/F Y - N '530 1 PKN I 800/2421 L- -- `NIP LEAIRD 2 ; u) O UNDER 1 N/F \ PC 1 /2424 ,d ; ,., y.ct? y PAVEMENT CLAYTON \ O r%.'" m 428/9 1 1 1 ' • 9 V T tsi V t n_ b. W N m • —1 v l t I CA .t 2- -1 NI 4. Harnett County Department of Public Health Well Construction Permit Application If the information in the application for a Well Construction Permit is falsified, changed, or the site is altered, then the Well Construction Permit shall become invalid. APPLICANT INFORMATION 0919 "1 /o - o&tto 11hcn Leuan Qrive ( ) ?D- D9IR Applicant/Owner Phone Number Pp TRIM ic `,cnradtop, t1.Ct. a�c Street Address, City, State, Zip Code The Applicant must submit a Site Plan. The Site Plan is a map /drawing of the property and must show: I. existing and/or proposed property lines and easements with dimensions; 2. the location of the facility and appurtenance; 3. the location for the proposed well; 4. the location of existing or proposed sewer lines and/or sewage disposal systems within 100 feet or the proposed well; S. the location of any existing wells within 100 feet of the property; surface water bodies; 6. above ground and/or underground storage tanks; 7. and any other known sources of contamination within 100 feet of the proposed well site. The Applicant shall notify the Harnett County Health Director through or by way of the Harnett County Division of Environmental Health if any of the following occur prior to well construction: I. there is a relocation of the proposed facility; 2. there is a change in the intended use of the facility; 3. there is a need for installing the waste water system in an area other than indicated on the well permit; or 4. there are landscape changed that affect site drainage. Contact information: Environmental Health Division - 910 - 893 -7547 PROPERTY INFORMATION Proposed use of well Single - Family Multifamily9 Church ❑ Restaurant Business ❑ Irrigation 11 • Street Address Subdivision/Lot # Parcel # PIN # • Directions to the Site See. ,» L jJ 1 have thoroughly read and completed this Application and certify that the Information provided herein is True, complete and correct to the best of my knowledge and is give In good faith. Representatives of the Harnett County Health Department and state omcials are granted right of entry to conduct necessary inspections to determine compliance with applicable rules. 1 understand that / am solely responsible for the proper identification and labeling of all property lines, underground utility lines, and making the site accessible sot that a will be properly constructed according to the permit n o.MMGt v` ?XNVVt. ilNs.fM„/ A - 1 -I1 Property Owner's of Owner's Legal Representative Signature Required Date NAME: APPLICATION #: II 50a 2 C a 9 V *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 dependi g upon documentation submitted. (Complete site plan = 60 months; Complete plat = without expiration) i t /4 j 910 - 893 -7525 option 1 CONFIRMATION # rJ 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. $25.00 return trio fee may be incurred for failure to uncover outlet lid. mark house corners and property lines. etc. once lot confirmed ready. • After preparing proposed site call the voice permitting system at 910- 893 -7525 option 1 to schedule and use code 800 (atter selecting notification permit if multiple permits exist) for Environmental Health inspection. Please note confirmation number given at end of recordina for proof of request. • Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits. ❑ Environmental Health Existing Tank Inspections Code 800 • Follow above instructions for placing flags and card on property. • Prepare for inspection by removing soil over outlet end of tank as diagram indicates, and lift lid straight up (if possible) and then put lid back in place. (Unless inspection is for a septic tank in a mobile home park) • DO NOT LEAVE LIDS OFF;OF,SEPTIC TANK • After uncovering outlet end call the voice permitting system at 910- 893 -7525 option 1 & select notification permit if multiple permits, then use code 800 for Environmental Health inspection. Please note confirmation number given at end of recording for proof of request. • Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting for remaining permits. SEPTIC If applying for authorization to construct please indicate desi ystem type(s): can be ranked in order of preference, must choose one. (_) Accepted (_} Innovative } Conventional (_} Any (_} Alternative {_) Other The applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer is "yes ", applicant MUST ATTACH SUPPORTING DOCUMENTATION: {_)YES (iJ NO Does the site contain any Jurisdictional Wetlands? (_ }YES {4} NO Do you plan to have an jrrigatint system now or in the future? (_}YES {$} NO Does or will the building contain any der f4S? Please explain. I_}YES (4.) NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property? (_} YES {4,"} NO Is any wastewater going to be generated on the site other than domestic sewage? (_ }YES (4.) NO Is the site subject to approval by any other Public Agency? {_)YES t4,.} 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 1 Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making The Site Accessible So Tha A Complete Site Evaluation Can Be Performed. n ( 44I oQ ! — 11 PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE 10 /10 How to Properly Mark Property for Soil Evaluation (MUST MATCH SITE PLAN) ink flag c iron pink flag ldb flag 4— nk ga e• USA . House flag range flag P ink iron r iron ROAD • PROCEDURES AND GUIDELINES FOR MANUFACTURED HOMES RA -30 Criteria Certification 1, f hr M.An" { Puc» 0 A ma rnn) , landowner /agent of Parcel Identification Number , located in an RA -30 Zoning District, do hereby certify the following: The multi- section manufactured home shall meet the following appearance standards, verified by zoning inspection approval, prior to the issuance of a Certificate of Occupancy: 1. The structure must be a multi- section unit built to the HUD code for manufactured homes. 2. When located on the site, the longest axis of the unit must be parallel to the lot frontage. 3. The structure must have a pitched roof that is covered with material commonly used in standard residential roofing construction. Said material must be installed properly and be consistent in appearance. 4. The structure must have masonry underpinning that is continuous, permanent and unpierced except for ventilation and access. 5. The exterior siding must consist predominantly of vinyl, aluminum, wood, or hardboard; and must be comparable in composition, appearance, and durability to the exterior siding commonly used in standard residential construction. Said exterior siding shall be in good condition, complete, and not damaged or loose. 6. The minimum lot size must be one (1) acre excluding any street right -of -way and the minimum lot frontage must be 150 feet as measured at the right -of -way line or along an easement whichever applies. 7. The tongue or towing device must be removed. 8. The home must have been constructed after July 1 1976. By signing this form, I acknowledge that I understand and agree to comply with each of the seven (7) appearance criteria listed above for the multi- section manufactured home I propose to place on the above referenced property. I further acknowledge that a Certificate of Occupancy (CO) entitling me to apply for electric service will not be issued until each appearance criteria has been met and approved. o,M , . 0 iv%A/ A.% ,0 - II ' Signature of Landowner /Agent Date By signing this form the owner /agent is stating that they have read and understand the information on this form 7/10