LAND USE Initial Application Date: 3-p 0 _ h1 Application # /1 5 2
CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 27546 Phone: (910) 893- 75�2t15 cc�� Fax: (910) 893 -2793 ,/� www.hamett.org /permits
LANDOWNER: 51 7 P1 C /I/ 1 nh l i. I OA Mailing Address)?5 tennis SM I7-II h es,
Cit FU u°- ()Asti ri/o State: /14 Zip:a'7S1 Contact# 55 - V/ Email:
APPLICANT': (Se,4r. 241 C -c cti +:‘ -anc Mailing Address: f d Soi yY 9,1
City: Caf es( State: /1( Zip: 275 Contact# V(t 9 62 Email: COST / y be / /S0.4. /ve
`Please till out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: {34'4{• -41 s C tMS 4 n.cfi u 1 i^L Phone # 9(P/ 9 3 6 b'
PROPERTY LOCATION: Subdivision: S Pq v 5 [(M' , do b-• Acv Lot #: 0 Lot Size: 1 5 ,- 5; AL
(
State Road # 1 2 3 State Road Name: ° en,+L P 5,4,.7 5,4,.7 it J / ,J'7 - 7 /(/ Map / B0000k &Page: /24 / 2 7 /�
Parcel: O 7 - 0 to 5 3 - 6 0 69 PIN: •b � / 7 3 -? / / - (n / / ao
Zoning: A 7 Flood Zone: 1 Watershed:_ Deed Book &Page: 2 / / 3 ✓ ' 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:
4 - 0 1 14 To CA IV beg - F , :t, c T.,ev, Lr.4'{ Oil
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PROPOSED USE:
Monolithic
❑ SFD: (Size, x —) # Bedrooms: # Baths: Basement(w/wo bath): Garage._ Jeck: Crawl Space: Slab: Slab:
(Is the bonus room finished? (_) yes ,..o w/ a closet? ( yes (Jno (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 (_Jno Any other site built additions? (_) yes ( )no
❑ Manufactured Home: SW DW TW (Size x 1 # Bedrooms: _ Garage: (site built? ) Deck: (site built ?
❑ Duplex: (Size _ x ) No. Buildings: No. Bedrooms Per Unit:
me Occupation: #Rooms: Use: r- Hours of Operation: #Employees:
Addition/Accessory/Other: (Size 3 x� b) Use: �e`�+ 6 Closets in addition? ( ) yes )no
oz po Wa r Supply: t County Existing Well New Well (# of dwellings 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? ( ) yes (_)no
Structures (existing or proposed): Single family dwellings: Manufactured Homes: Other (specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum -1, C Actual / Se P a /! f / •
Rear 7f Z619 W " t&ra yC / 4 10 J4 •
Closest Side 1— 0, 6
Sidestreet/corner lot
Nearest Building
on same lot
If permits are granted I agree to conform to all ordi• - • - s and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing statements are -.:.• ate a • correct to the best of my knowledge. Permit subject to revocation if false information is provided.
.'(1 . - of s ner or Owner's Agent Date
* *This app ation 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
4 LEGEND �I
SMITH O
.EN j' c RD c �'
Lines Surveyed S
\ .l o Lines not surveyed
s F 9 m a E.I.P. Existing Iron Pipe n
F I.P.S. Iron Pipe Set h
° P.P Power Pole
HvN 4Dt nY M.H. Manhole I II o
80' 40' 0 80' t
VICINITY MAP INT.S.) I (
GRAPHIC SCALE
1"= 60' L I
No. Bearing _ Di_s_tance__
L — N 02 °49'06 "E 7.26' I
I_L2_.._N 02 °49'06 ".E ._._ .___4.90'......1
N/F
ANDREWS
1 \. POINTI
IN ROAD
1 IPS
5 79115'46"E
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HELL i.
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GARAGE 3.33 AC. m
TO CENTERLINE °
va ROAD w o
Z Z Z ° S 90.8'___
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,\^ � In w °' m r "�� - C A RPORT
V m NX70DEN
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DRIVE / • O
73 V
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SEPTIC
ANK
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—I N ORIVE\
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ate ,-; WJI ,!• L OVERHEAD POWERLINE I \'\ %�
I • Qe e . \ SIPS PP N83 °53'38" P.P.
SEAL 40 ACCESS EASEMENT 376.66' EIP
t 7� L3309 At/
11-9 S UF;4 QQ: 23 - -
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LOT cq'�6MRNEi ACRES,
RECORDED IN PLAT CABINET C, SLIDE 127 -B, HARNETT CO.
I PROPERTY OF
1 David W. Barrier,certify that this plat STEPHEN TOASO
was drawn under my supervision from BONNIE TOASO
an actual survey made under my
supervision; that the boundaries not 285 LENNIE SMITH RD. FUQUAY VARINA, N.C.
surveyed are dearly indicated and any
encroachments are shown. SCALE; 1 °_80' II,I,, 1 1'i ii, u i ter
DATE; 3/8/11
1 - 1 : : , D i l i ' 0 ' 1 ,AN(., ; 5 - ? .- - 0 -- 2 - . ._._-____ Li I I , N.(' , 1; )I i
BOOK; M- 220 -62
NAME: APPLICATION #: 1 5 2 6 23‘. 3
•
*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 #
❑ 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 0 be addressed within 10 business days after confirmation. $25.00 return trip fee may be incurred
for failure to uncover outlet lid. mark house corners and property lines. etc. once lot confirmed 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 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.
E nvironmental 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 , inplace. (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.
f_) Accepted (_) Innovative {_) Conventional (_1 Any
(_) Alternative 4_1 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 (_) NO Does the site contain any Jurisdictional Wetlands?
(_)YES (_) NO Do you plan to have an itri eation system now or in the future?
(_)YES {_J NO Does or will the building contain any slr;ii ? Please explain.
I — }YES I — NO 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?
J___) 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?
(_) YES f_) NO Does the site contain any existing water, cable, phone or underground electric lines?
If yes please call No Cuts at SO'0- 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 Identificatir4nd Labeling Of All Property Lines And Comers And Making
The Site Accessible So That A Complete Site Evalua n Performed.
PROPERTY OWNERS OR OWNERS LEGALRtEOHE E SIGNATURE (REQUIRED) DATE
U
10 /10
•
DIAGRAM OF A TYPICAL SEPTIC TANK
1 - mat LID
D
POSSIBLE POSSIBLE
HOUSE HOUSE
CONNECTION - CONNECTION
7
POSSIBLE
HOUSE
CONNECTION
POSSIBLE LID SHAPES
1 I SQUARE (SHOWN ON DIAGRAM)
0 RECTANGLE (OLDER TANKS
0 ROUND
How to Properly Mark Property for Soil Evaluation
(MUST MATCH SITE flag
c• lite
pink flag — n g
1 L ♦— • flag
on
Howe
it,
n � ea
gc te
P
iron it
iron
ROAD