LAND USE Initial Application Date: // q � / ✓ Application* /0 soy S`S 749
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 27548 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.harnett.org /permits
LANDOWNER: Lake Carolina Homes Mailing Address: P.O. Box 366
City: Snellville State: GA zip: 30078 Contact# 770.978-0804 Email: Jimmyray33 @yahoo.com
APPLICANT`: Mailing Address:
City: State: Zip: Contact # Email:
`Please fill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: Jimmy Ray Phone # 704 - 571 - 1178
PRn7ERTY LOCATION: Subdivision: Carolina Lakes Block Ti Lot #: (1 Lot Size: acres
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State Road # 1115 r, 8 State Road Name: Buffalo Lake Rd q ,/L Map Book&Page: / Lt'"i' J
Parcel: 031 0' o20 — Q70 PIN: 9S () S Ste( 397 f
Zoning: 020R Flood Zone: N/A Watershed: N/A Deed Book &Page: 2794 838 Power Company *: Central
New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Go to Carolina Lakes Subdivision go through the guard gate and take a
right turn onto carolina way, follow to coachman way turn left - 'p (UV 1 (of ON Lair
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PROPOSED USE:
c-�
y, Monolithic
l ' SFD: (Size 56 x 5 o) # Bedrooms: 5- # Baths: Basement(w /wo bath): Garage: it Deck: Crawl Space: Slab: Slab: J
(Is the bonus room finished? (_) yes (__)no w/ a closet? (_) yes (_)no (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 ( Any other site built additions? ( ) yes ( )no
❑ 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: ! 7 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? (_J yes ( Ina
Structures (existing or proposed): Single family dwellings: 1 Manufactured Homes: Other (specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum 35 Actual 38
Rear 25
T
a
Closest Side 10 C
• Sidestreet/corner lot 20
Nearest Building
on same lot
If permits are granted I agree to conform all ordln noes an laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing statements e accura and rrect to the best of my knowledge. Permit subject to revocation if false information is provided.
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Signature of ner or Owner's Agent Date
**This applica on 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
Re klential Land Use fLaplissalion seeLe 1 a: 1 1
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SITE PLAN APPROVAL
DISTRICT
USE
*BEDROOMS 'w�
Date -_ -- - - -- ion.
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FOR R €g�ISTRRaTI R OF DEEDS.
HARNETT COUNTY TAX ID# T T OUNTY, NC
20100CT1
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• BK:2794 PG :838 -840 FEE :$22,00
(Wi IN SCBRE N i7N24LOB fi 35
NORTH CAROLINA
GENERAL WARRANTY DEED
Excise Tax: $1,080.00 Verified by County on the day of ,20_
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Tax Map No. Parcel Identifier No.
Mail i bf e r A rding to: McGeachy, Hudson & Zuravel, 555 Executive Place, Fayetteville, NC 28305
This Instrument was prepared by: Trey Inman & Associates, P.C. 1801 Peachtree Street, N.E., Suite 225, Atlanta, GA 30309
THIS DEED made this 8th day of October , 2010 by and between
GRANTOR
MEDALLION CONSTRUTJON GROUP, LLC. P.O. Box 2476 Matthews, NC 28106
GRANTEE
LAKE CAROLINA HOMES, LLC. P.O. Box 366 Snellville, GA 30078
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall
Include singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby
acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain
lot or parcel of land and more particularly described as follows:
BEING ALL OF LOTS 2, 3, 6, 8, 9, 10, 11, 199, 200, 201, 211 AND 212, AS SHOWN ON A PLAT ENTITLED "FINAL
PLAT", CAROLINA LAKES, PHASE SEVEN, BLOCK "T1 ", SAID PLAT BEING DULY RECORDED IN PLAT CANINET
"F ", SLIDE 495-D, HARNETT COUNTY, NORTH CAROLINA REGISTRY.
PARCEL ID: 9585-55- 6292.000
PARCEL ID: 9585-55-8129,000
PARCEL ID: 9585 - 55-9131.000
PARCEL ID: 9585-64- 3739.000
PARCEL ID: 9585-64- 4861.000
PARCEL ID: 9585 -64- 5882.000
PARCEL ID: 9585 -64- 7814.009
PARCEL ID: 9585-64. 8610.000
PARCEL ID: 9585-64- 5718.000
PARCEL ID: 9585-64-6517.000
PARCEL ID: 9585- 54-7907.000
PARCEL ID: 9585 - 55-5046.000
A Map showing the above described property is recorded in Plat Book F Page 495D
The above described property ❑ does does not include the primary residence of the Grantor.
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TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the
Grantee in fee simple,
And the Grantor covenants with the Grantee, that Grantor Is seized of the premises in fee simple, has the right to convey the
same in fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and defend the
title against the lawful claims of all persons whomsoever except for the exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has caused this
instrument to be signed In Its corporate name by its duly authorized officer(s), Me day and year first above
wrltten.
Medallion Construction Grou • L (SEAL)
B y : �� (SEAL)
1 ; I r-7r!S is.c4
By: (SEAL)
Title:
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11____��/1 (SEAL)
NORTH CAROLINA etttR. rxwJArlid COUNTY
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she signed
the foregoing document: Witness my hand and official stamp or seal, this the day of
, 2010 , •
My Commission Expires:
Notary Public
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Print Notary Name:
NORTH CAROLINA COUNTY
I really that the following person(s) personally appeared before me this day, each acknowledging to me that he or she signed
the foregoing document: Witness my hand and official stamp or seal, this the day
of , 2010 .
My Commission Expires: _
Notary Public
Print Notary Name:
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State of North Carolina County Of Cumberland
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I a Notary Public of the County and State aforesaid, certify that James R. Duckworth,
personally came before me this day and acknowledged that he is Member /Mgr. of
Medallion Construction Group, LLC, a North Carolina Limited Liability Comapny and
that by the authority duly given and as an act of the Entity, has signed the
foregoing instrument in fiat name and on its behalf as its act and deed.
Witness my hand and official stamp or seal, this 8th day of October, 2010.
411 ' // ' (Seal /Stamp)
ii , / i , &2l /e,u Notary public, North Carolina
Notary s name printed or typed Cumberland County
My Commission Expires
My Commission expires: 2/24/2014 February za,zola
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