SEPTIC D19 MfI'7
Application # /1 ,5 2 / % 4
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910 - 893 -2793
www.harnetlorg/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: L ck A , S' e i lna ✓c( Date: N1 r-t - Zb l (
Address: '1 113 4 t)eks VC '2-3
Telephone: ctO - OS7t%
Property Owner: P rot '{ ✓S 11. V — \- Phone°tfC7 -4(c10 3(�FSy
Lot Address: 5 k Lo f4 N est 9 4 d 5 e , lb vac, I way if/C Z 7 SO 5
Name of Park: Ecks le s La t - 5 A4 k ( Lot Number: Z(
Parcel: a3 94_ 7 004/ PIN:
X SW _DW _TW (Size 1 k x 1 ) # Bedrooms Z Year g
Power Company: P ry>3v esS Ehr osy (For Progress Energy we need the premise number.)
1 . 1 ZS 1- te 7 - a-Lt Pt'c tents it
Specific Directions to Job from Liliinoton:
L Z? Sovct left ivc F_c5 e Lct ivts M!1-0 / Z 1tft
r 5k a0 - '1 - te ego o tie skm eeFotfo Lofk�
Alec' Qic&s-e s t4e e1/44 otA e vg
There is a $100.00 charge for this service. This certification is subject to revocation if the
Intended use of the septic system changes, or If false Information Is provided on this
application.
You signature below certifies that all above infgrm on ' corr t.
Signature of owner or authorized agent: it
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environmental Health Specialist Date
SEPTIC 4/08
2C 9Y4
NAME: APPLICATION #: Il 57;717 7 4 1:7
*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 #
❑ Envlronmental Health New Septic SvstemCode 800
• All properly 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 Tots to be addressed within 10 business days after confirmation. $25.00 retum trip fee may be incurred
for failure to uncover outlet lid, mark house corners and property lines. etc. once lot confirmed ready.
• Atter 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.
■ Envlronmental 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 Iniplaca. (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.
1_1 Accepted ( Innovative {_} Conventional 1 - Any
(_) Alternative (_l 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:
I_) YES 1 -1 NO Does the site contain any Jurisdictional Wetlands?
{_}YES (_) NO Do you plan to have an irrieation system now or in the future?
{_ }YES (_} NO Does or will the building contain any drains? Please explain.
I —}YES I — NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
(_) YES (_l 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 (_) NO Are there any Easements or Right of Ways on this property?
{_IYES (_) 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 Ar anted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I Unde nd 11 A ely / I nsibyr The P ' . er Identification And Labeling Of All Property Lines And Corners And Making
The it cce That • omple '' to Ev ; Ion Can Be Performed.
Pale tO 1 1
PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
10 /10
HoCar Properties
P.O. Box 1189
Broadway, NC 27505
919.258 -5504
Jholly117Q yahoo.com
Rental /Lease Agreement
1. This agreement Is between HoCar Properties, LLC, hereafter referred to as "Landlord ", and
r,4M A . Sk P ✓' cw e hereafter referred to as "Tenant ".
2. Tenant agrees to lease /rent the described mobile home lot #8, lot #25, lot #26, lot #27 In Eagles
Landing Mobile Home Park, Broadway, NC, 27505 for the sum of $125.00 a month each.
Payments shall begin on March 1 ", 2011 and shall be due on the 1" of each month thereafter.
4. Payments not paid by the 15 "' of each months shall be subject to a $55.00 late fee. Failure to
pay the late fee shall be the same as failure to pay the original rent. HoCar Properties will begin
the eviction process on the 16"' of the month unless prior arrangements have been made.
5. Tenant agrees to pay a N/A security deposit that shall be refundable provided the tenant gives
at least a 30 day notice (after initial 12 month period) of moving and the property Is clean and In
the same condition as when tenant moved in. The security deposit is non refundable if tenant
owes landlord any back rent.
6. Tenant agrees that he/she will keep the lot in good condition to Include keeping grass mowed
and lot clean. Tenant shall not have trash, Junk cars or appliances, large or vicious animals or any
other activity that could be considered a nuisance by neighbors, Including loud parties or music
and excessive traffic In and out of the home.
7. Tenant agrees that he /she will not possess, sale or use Illegal drugs on described property, or
allow any other guest or visitor to possess, sale or use any illegal products. Tenant also agrees
that he/she shall not use the home for any other activity that Is in violation of state or federal
laws.
8. Animals kept outside the home must be kept In a manner that complies with any local animal
control ordinances and in a manner that does not Intrude upon neighbors.
9. HoCar properties shall provide lot and trash pick up only
Tenant information: pp
Full NameC ° NOk A • sLty v a ^�1
Mailing address 0.0 Box l.\3'-t 1 Vass Pe- Z 'r3 °1L?
Phone Number a k‘.0 e ttC:S(o "d 5 ' C
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