LAND USE •
— Initial Application Date: 2 11 Application # 1 / 9.72P 7(/J /
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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.harnetLorg /permits
LANDOWNER: 4T4tie- 60 c'O,QrM1) Mailing Address: '?//7 "new e,e//SG PA
City: &tit Ada? ' 14 / /- t'P
State Zip: _777 ontact # - 9t 7 eF /of Emai
APPLICANT': �Ojhr r 4o 67 Mailing Address: 3 3e/ 0 ra c' r,e__roA, )79✓i r // 'e/
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// 4` 13,-cC.c. tarns /
City: 63rD State:/UC, Zip: 7/ Contdct # f66 -° ir7 -2 f YB Email: f? C: HOOD /. viimits, C'crb.
'Please fill out applicant information if different than landowner OO
CONTACT NAME APPLYING IN OFFICE: Le, - -' C4 ).. 1 Phone # ».2 - ?53 y J
PROPERTY LOCATION: Subdivision: ( �T /z t 5 /40<' Lot #: / Lot Size: a / % //`
State Road # '`7 n ,1,vsfl Road Name: // / v � Map Book&Page: Z'Po/ / q/
Parcel: 27 ✓ 6 / I r7 0 1 1/� PIN: 5 /
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Zoning: v Flood Zone: / Watershed: Deed BookBPage: 2 l ? � 1 j4O 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:
2-7c 're \o+rrs SST 2 onro f3, "C/S t, // R // 4 Fe CtF'r
rr C:irrcY Lilf<E (P r, C-S777 6- fi Kt 0-- C'o f+n /c% C. 77 57_/
PROPOSED USE: Monolithic
❑ SFD: (Size _ x _ ) # Bedrooms: # Baths: Basement(w/wo bath): Garage: Deck: Crawl Space: Slab: Slab:
k7 ,(Is the bonus room finished? ( yes ( w/ a closet? ( yes ( (if yes add in with # bedrooms)
Mod: (Size '215 ) # Bedrooms # Baths Z Basement (w /wo bath)a Garage:AVn Site Built Deck:/4 On Frame Off Frame v
(Is the second floor finished? ( yes ( V)no Any other site built additions? ( yes ( Vino
❑ Manufactured Home: _SW _DW TW (Size _x) # Bedrooms: _ 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 (7 Existing Well New Well (# of dwellings using well ) 'MUST have operable water before final
Sewage Supply: New Septic Tank (Complete Checklist) V 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? () yes (_)no
Structures (existing or proposed): Single family dwellings: Manufactured Homes: Other (specify):
Required Residential Property Line Setbacks: Comments:
4
Front Minimum /' Actual 34, 1
Z Rear ` / y --,J
�� Nr/Q
Closest Side �L_c_`U
SidestreeUcorner lot
Nearest Building
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 statem- is are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
- • 2/2///7
Signature of Owner or Owners 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
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NAME: APPLICATION #: 1/ CCP 24 I�+�
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 1S 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 SvatemCode 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 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 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 Existino 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 desired system type(s): can be ranked in order of preference, must choose one.
(_) Accepted (_} Innovative (_) Conventional {_1 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:
O YES { f NO Does the site contain any Jurisdictional Wetlands?
(_}YES {(e(NO Do you plan to have an irrieation system now or in the future?
{_}YES (jc NO Does or will the building contain any rite ? Please explain.
(_ )YES f ✓) NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
{_1 YES {LINO Is any wastewater going to be generated on the site other than domestic sewage?
L...) YES (!'1 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?
(_ }YES 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.
1 Understand That I Am Solely Responsible For The Proper Identlfcadon And Labeling Of All Property Lines And Corners And Making
The Site Accessible So That A Complete Site Evaluation Can Be Performed.
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PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DA
10/10
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6 1° 11111
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Mail : '• � Earl and Virginia Boudreau
2114 Memorial Parkway
Portland, Texas 78374
This ' N. EARL JONES,JR.,
ATTORNEY AT LAW
Brief description f• . 4 0 Lot 42, CottleStone Estates
NOR • GENERAL WARRANTY DEED
O' E SEARCH)
1 THIS DEED made thi • '14ay • .r_ • 110, by and between N. EARL JONES, JR.,
and wife, DIANE B. JONES, 30 C .. 'we, Coats, North Carolina 27521, Grantors,
and EARL RAYMOND BOUD' ' wife, VIRGINIA T. BOUDREAU, 2114
Memorial Parkway, Portland Texas Grantees.
The designation Grantors and Grantees : - ' shall include said parties, their
heirs, successors, and assigns, and shall inc • pl • masculine, feminine or neuter as
required by context.
WIT SS
THAT the Grantors, for a valuable conaide :. • y . Grantees, the receipt of
which is hereby acknowledged, have and by these • ...... ,► • •• • bargain, sell, and convey
unto the Grantees in fee simple, all their interest in , : . - I of land situated in
Grove Township, Harnett County, North Carolina, • • .• • described as follows:
BEING all that certain 0.60 acre Lot numbered 42
on Map of survey entitled "COTTLESTONE EST
Grove Township, Harnett County, North Carolina, • : •.: •
19, 2000, prepared by Bennett Surveys, Inc., and being - .. •. -.
at Map Number 2001 -912, Harnett County Registry, sai • 1
being incorpmete.d herein and made a part of this desc • .. •
though %fly set out herein.
The herein described land is conveyed to and accepted by
subject to all those tenns, provisions, covenants, and conditions
forth in those Declaration of Protective Covenants dated April 11,
2003, and recorded in Book 1750, at Page 277, Harnett County
Registry, which protective covenants are by reference incorporated
in and made a part of this conveyance. And tits Grantees herein
acknowledge that they have been furnished a full and complete set
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