LAND USE Initial Application Date: 2/ — /` Applk:allon # / [ 5 2 /l /�
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COUNTY OF HARNETT RESIDENTIAL LANG USE APPLICATION
Central Permitting 108 E. Front Street, Langton. NC 27548 Phone: (910) 893 -7525 Fax: (910) 893 -2793 1��. www.harnet.org/permits
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LANDOWNER: Wfln i t ( WI tent) Mailing Address: 13 &vio I tit? Dc -
Cit F.(Ir JV4y - l in( r. state: A)( m /97-ga Home #: ?/9 - 05 a 7 ?:1 t / Contact #: 13 5- gOf G. APPLICANT': Rorl n1 Q Au2x.' Melling Address: 1 3. S.h-t o ketr .0r.
city: J Ufwi raa Stale: 41 Zip:a 7 5 - a C Home #: Contact #:
'Please fill ou appl Information if different than landowner /�
CONTACT NAME APPLYING IN OFFICE: R rl N, Q 4t.tz_ -f ( / Phone #•. 919 -- 5 ) - 79 y
PROPERTY LOI�TIQt1L., Subdivision w/phase or section: ! . / 1' , B Lot #: .. Lot Acreage: /, 77
State Road #: .., // State Road Name: / / / d l / � 1 . / Map BookaPage: .46 /
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Parcel: !/ 9 t 5 Z a ii PIN: Oh C2 — 7 — a4 2g av
Zoning: 4 g Flood Zone: )( Watershed: , Deed Book &Page: 27&,1 / 7.5 Power Company:
New IxRnes with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPE FROM ULLINGTON: 14 V YO 1 G-17 i ✓tC J 4.) k)c -v-O! - u µ. y (.1 (�.{ , ` y�e
Ri /tit NJOIP∎14 -Hail 1 � • 3 1 'D cl I inorin,c.ai -1-Q L.,1 I I by 0.-1
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PROPOSED USE: Circle_
❑ SFD (Size x ) # Bedrooms # Bats Basement (w/wo bath) _ Garage Deck Crawl Space / Slab
(Is the bonus room finished? w/ a closet If so add in with # bedrooms)
❑ Mod (Size x ) # Bedrooms # Baths Basement (w/wo bath) Garage Site Built Deck ON Frame / OFF
/ (Is the second floor finished? Any other site bill additions ? )
fi Manufactured Home: X SW _ DW _ TW (Size ti x 76) # Bedrooms 3 Garage _ (site bull? ) Deck (site built? )
❑ Duplex (Size _ x ) No. Buildings No. Bedrooms/UnIt
❑ Home Occupation # Rooms Use Hours of Operation: #Employees
❑ Addition/Accessory/ Izex ) Use Closets in addllonLJyes Lino
Water Supply: Cou L) Well (No. dwellings ) MUST have operable water before final
Sewage Supply: New Septic Tank (Complete Checklist) U Existing Septic Tank (Complete Check#sQ LJ Sewer
Property owner of this tract of land own land that contains a manufactured home wAn five hundred feet (500') of tact listed above? ES L)NO
Structures (existing & proposed): Stick Buil/Modular Manufactured Homes Other (specify)
Required Residential Property Line Setbacks: Comments:
Front Minimum / ] Aotuai 1 37
Rear 2 4 2
Closest Side 1O L.
Sdestreet/corner lot
Nearest Building
on same lot
If permits are granted I agree to conform to all ordinances and laws of the Slate of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing statements are accurate and correct to the beet of my knowledge. Permit subject to revocation If false information is provided.
Signature of Owner or Owner's Agent Date
"This application expires 6 months from the Initial date If no permits have been Issued"
A RECORDED SURVEY MAP, RECORDED GEED (OR OFFER TO PURCHASE) AND PLAT ARE REOUWED WHEN APPLYING FOR LAND USE APPLICATION
Please use Blue or Black Ink ONLY
LAND USE 5/08
SITE PLAN APPROVAL USE Z DISTRICT
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NAME: �0 NA, l c 4Uff/ APPLICATION #: 1/ SOD 2 1 /4
*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) / 75`
910 -893 -7525 option 1 CONFIRMATION #
Environmental Health New Septic SystemCode 80
• 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 comers.
• 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 atlfor 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 confined readv.
• 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 N multiple permits exist) for Environmental Health Inspection. please note
confirmation number akin at end of recording for Proof of rawest,
• Use CIIck2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
❑ Environmental Health Exisdnrs 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 (i/
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 8 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 system 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 (zi5(O Does the site contain any Jurisdictional Wetlands?
{_} YES (LI NO Do you plan to have an imeation system now or in the future?
1_) YES ( Does or will the building contain any (Joni? Please explain.
(____J YES (Lt y Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
(_) YES NO Is any wastewater going to be generated on the site other than domestic sewage?
(_) YES 1 Is the site subject to approval by any other Public Agency?
O ES ) 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.
1 Understand That 1 Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site Ac essibie So That A Complete Site Evaluation Can Be Performed.
PROPERTY OWNERS OR O LEGAL REPRESENTATIVE SIGNATURE (REQUIRED) DATE
5/08
2. The home must be underpinned, consisting of a brick curtain wall or have
galvanized metal sheeting, ABS or PBC plastic color skirting with
interlocking edges, installed around the perimeter of the home. Skirting
shall be consistent in appearance, in good condition, continuous,
permanent, and unpierced except for ventilation and access.
3. The homes moving apparatus must be removed, underpinned, or
landscaped. (See examples below.)
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Signature of Property Owner / Agent Date
• By signing this form the owner / agent Is stating that they have read and
understand the information on this form.
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FOR REQI5TRaTION Rxa a or MEN • : . COUNTY TAX ID# 2010 T 11 :I PM
AP BK:2741 PG;709 -792 FEE: ,00
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Exebte Tar S 70.00
Pesoel identifier No.0.•.521,:: County mthe day of ,Z1
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MaiVBorto: REGINALD B. KELL 90J : • • 1LLINGTON. NC 27546
Ms behttmattwaspeepamdby: REG a : . 1 ` IN STREET, LILLING'ION, NC 27546
Brief description liar the Index: LT CONTA' i t P. S,
THIS DEED made this I lth day of May • 20J, •
GRANTOR 1110IP GRANTEE
Ronald L. Hall and wife, Ro • G. Avery and wife,
Katie H. Hall ••. • very
7178 US 401 N es' S n = Drive
Fuquay Varina, NC 27526 / F wy NC 27526
The designation Gramm mid Grantee as used bant shall include mid .-.z.• end Insigne, and shall include
singular. plural, masculine, braining or muter as mgabed by mint.
WITH ESSETIL ther ea t: raalor, for a valuable comideradon paid byte Grantee, • - .1; . . hereby aeimowiedged, S
sal byt besepresentsdoesgra ntbergVS ,selandcomroyualotbsCtatdeeiobe , t.... 1 .,;Sor pared oflmdStated
in the a yof FUQUAY VARINA , HECTORS CREEK Township, ' • • ,. ,NattiOnolloaand
more perdu-nib/1y desartbed as follows:
See Attached
Tice property berelnabove described was acquired by Grantor by instrument recorded in Book 2155 .
A map Swing the above described property is recorded in Plat Book _ page
NC Bar Association Form No. 1-3 0 1976, Revised 01977, 2002
Printed by Agreement wit to NC Bar Asaodaden —1981 SottPro Corporation, 333 E. Six Pot Rd,