LAND USE Initial Application Date: 2 I /--- [! Application* / 5 2,5
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• COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street. Langton, NC 27548 Phone: (910) 893 -7525 Fax: (910) 893-2793 www.hgmett.orgipermlts
LANDOWNER: �e '/ o� (71 j N
ailing Ad dre s s:..-- Z @ 1 Lori 0 2
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APPLIC NT': ( � /Il/T� . ?/i. rL Mailin /dJ �esa: ' ,n l L.lt"/V
City: / 0' / IIIL « stateNt ;a. MContact lv✓ K/"�VN Email:
'Please all out applicant Information If different then 1 er /L wLI 6 N I
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CONTACT NAME APPLYING IN OFFICE: F 2 L/�'f � 869 v QQ ) � /b V Phone # (�
PROPERTY LOCATION: ubdNtsion: Lot #: Lot Size /
State Road # L ° 37 State /} R oad Name: �t Q / Map Book&Page: L '�� / 573
Parcel: / ,95-14. (//1.7 ,/ PIN: O / 'y7�— 15 COO
Zoning: !f k 2 % %food Zone: X Watershed: Wei Deed Book&Page: bb // / / L ? Power Company':
*Nev, structured with Progress Energy as service provider need to supply premise number _ from Progreso Energy.
SPECIFIC DIRECTIO . a TO THE PROPER FROM ULLING ON:
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PROPOSED USE:
Monolithic
❑ SFD: (Size _ x ) # Bedrooms: • Baths: Basement(w/wo bath): Garage: Dedc: Crawl Space: Slab: Slab:
(Is the bonus room finished? (__) yes ( _Jno w/ a closet? („_) yes Lino (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? ( J yes (Jno Any other site built additions? (J yes (ono
❑ Manufactured Home: _ SW _ DW _ TW (Size x 1 Bedrooms: _ Garage: (site built? ) Deck: (site built7_J
❑ Duplex: (Size x ) No. Buildings: No. Bedrooms Per Unit:
❑ Home Occupation 8 Rooms: Use: Hours of Operation: #Employees:
gfAdditlorilACrsseory! ri(SW"'�° �a �+ Uae: a. f�?r���r+•+ n...---.—----•••- _>"`"^Closetsin'edditlon7(J;Yesr • no««y
( /fie - .. .�s,u�;nw+..n�.:.�w+,...• -- -_.
Water Supply: .� County Existing Well _New Well llinga 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? (J yes (ono
Structures (existing or proposed): Single family dwellings: Manufactured Homes: Other (specify):
Required Residential Prope Line Setbacl / Comments:
Front Minimum 3L Actual 2 / ] , 9 r
Rear 2 4— // 91
Closest Side i" / a
SidestreeVcomer lot _
Nearest Building
on same lot
If permits are granted I agr- . conform to al rdinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that forego' • - tat -ments are r to and correct to the best of my knowledge. Permlt subject to revocation If false Information is provided.
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� 81 Owns ►,ar.Owners'AgeMC!#a;&Ea,.
"This application expires 6 months from the Initial date H permits have not been Issued"
A RECORDED S VEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
SFD, Addition, Modular Application 3 of 8 08/10
SITE PLAN
PROPERTY OF:
.
FRED DOUGLAS ELLIOTT
1050 Milker Road. Linden N.C. 28306
STEWART'S CREEK TWP., HARNETT COUNTY. N.C.
SURVEY BY: JOYNER PIEDMONT SURVEYING
License No. F -0712
100 East Cumberland 51rat. P.0. dot 115. Dunn. N 26550
anon. 19101 692 -2011
Map « a
: gld 59a
ZONE: RA -2OR DECEMBER 16. 2010 SCALE: 1" .40' •
NOTE: Deed Reference;
P,,, r 1 rMV Deed Book' 668, Page'.. 965 `Ic' \4 AA ,,
e mna. Map a 2010 - 513.: ` k tN Ca
PIN a 0545 -39- 7693.000 s = t �I. y
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Mary E. • Eason e b 1
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Henry W. Elliott __ o o_ - -
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Deed Book 1164. Page 467 1 e'e I, n ' m
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16' .2 .- 1 Henry W. Elliott
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Oe annle cN 1835 �. tr . 8 v.' FRe burr: a aa - IDeed Book 1164. Page 467
etl Bo 6 a al 0 Plat Cabinet T " SIIde 573 -D
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Lonnie M. Elliott I 1
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116.00 FW.n I
Henry W. . Elliott
- 'Deed Book 1164, Pape 467 i
1 • Plat Cabinet "F". Slide 573 -D n
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NAME: 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 CO NFIRMATION #
❑ Environmental Health New Septic System Code 8 00
• All property Irons must be made v Isible. Place "pink p roperty flags" o n each corner i ron of lot. All property
lines must be clearly flagged approximately every 50 feet between comers.
• Place "orange house comer flags" at each comer 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 retum trip fee may be incurred
for failure to uncover outlet 11d. mark house comers 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 En vlronmental 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 Cod a 800
• Follow above instructions for placing flags and card on property.
• Prepare for inspection by removing soil over over outlet end as diagram indicates, and lift lid straight up Of
possible) and then close back down. (Unless inspection is for a septic tank in a mobile home park)
• After uncovering outlet end call the voice permitting system at 910 - 893 -7525 option 1 & select notification permit if
multiple permits, then u se code 800 for Environmental Health ins pection. 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.
{ ccepted { } Innovative {J Conventional , Any
{ } Altern: d e L} Other
The applicant shall no ' - the local health department upon sub ' of this application if any of the following apply to the property in
question. If the answer is "y-<" applicant must attach sup.• g documentation.
{ }YES I} NO Does the site • . . urisdictional Wetlands?
(_)YES XNO Do you plan to ' • e .. ' • , i'• I :t - yin now or in the future?
{ }YES NO Does or the building con • tats? Please explain.
{ ec NO • ere any existing wells, springs, war, ' • es or Wastewater Systems on this property?
L }YES 6 s Is any wastewater going to be generated on the site o • than domestic sewage?
{_ } YES ,,,,c1 NO Is the site subject to approval by any other Public Agency?
L} NO Are there any Easements or Right of Ways on this property?
{_ " S Z 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 Th .1 Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Comers And Making
The Site Ace - � So That A Compl t ite nation Can Be Performed. /
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MOPE; OWNE • OR 0 R ERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
SFD, Addition, Modular Application 4 of 8 08 /10
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.Vetdhed by •_,_. -_ _ _ . ------- _ County en the dW ef ...... ........_.._•.....______, 1at.__
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This Instrument wasp u by .. -envy or., Attorney at Law, L11IfOgtoiThe
Brief daurfptkn for the dex ,
NORTH r ' ? d I, GENERAL WARRANTY DEED
• I TEtS DEED mute tbi.'. -MA,. • _� azr, SY._._, __...,._.____.79_ ,.. by and between
1 . GBAtiTO ^ GRANTEE
' EENWC WELDON nit Tir . • FRED DOUGLAS =non, '
FLORENCE c. ELLIOTT of : -. of Harnett County, North
County. North Carolina Carotins;
• i 668 0965
Ear La ipprep.tate block at ,..b ray: Mar, adds , and. p a ssre ar eaixn e,. u.ew.11se et, galas IN. ,
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The desismtion Groner and Grantee as used herein shall etc .al pa es, thedr help, sueetiibn,pnd swum and
' shit Include .Insular, plun4 masculine, feminine or neuter as eon d b context. e • t
e WITNESSETE, that the Grantor, for a valuable consider* 'on paid ranted, the renlpt of which I. hereby
• aelmawledsed, has and by Moe pmeata doea smut bargain. :t n ...ray to the Grantee fa foe'Mialple, all that
• certain et or parcel of land aituatedd in the City of _ ........ _ .................. • ••••••• , _., Sjrewa ;t' a .tr'e. 615.. Towtgt:Ip•
''IN ,
• ._.._ .._....ASILDRfrer..__, ..... ._., County, North Carolina and more portico arty .escr .ed .s follows:
' BEGINNING at a point in the center of SR 2.4- •e •• .0 feet more or lass
ftom a corner with the Clark property; the -= 2 • 9 • grees 15 minutes
East 116 feet along the center of said road. - ) p.- t in the center of •
a cultrert and set nail in roadway; thence- South 3 • gr•= - 15 minutes West
375.83 feet to a new corner in Elliott Propert ; •, S•uth 9 degrees
15 minutes East 116 feet to a new corner; then -- •egreees 15
minutes East 375.83 feet to the BEGINNING, con - •ing - . store or- less.
For a more particular description reference is . a • at and survey
by Hickey E. Bennett, Registered Surveyor, dated F 4, 978, which
is attached beret* marked "Exhibit A" and incorpora -• • - -in fully as if
set forth. ,
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TO HAVE AND TO . a , . • .' - P. •• or panel of land and all plagues and apymtaaaaua tbantn belmtb! to
Oa Gant* in tee . +• • .
j And the Grantor coven= se, that Greeter la mind et the premium In tee ample. bee the r4bt te tower
1 the same Ill Ala almple. t - - . N and free and clear of all encumbrances, and that Grantor Will warrant and
derend the the aaalnn althea . • alaa of persona whomsoever' ra for the exception[ hereinafter stated. -.
Title to the property h • ., d... . saint to the following eseeptlon: -
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