DOCUMENTS Initial Application pate'. `3VI I I Application* In) , O04 I ) a \
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street,Lillington.NC 27546 Phone.(910)893-7525 exf2 Fax.(910)893-2)93 wwwhamett erg/permits
"A RECORDED SURVEY pMAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER: \.IAAAAG L(AA'Jp I��s Tailing Address- SANA.G 4.S be ibNs)
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City: U State: n Zip' t t•
Contact No. Email: i ban h O r rI s I 157 Q l/µTlpO,
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APPLICANT': tutme,6RCM,Jn (4ON•aIIA ling Address: P. O . T3Du `Taal
crty. Nisi lJ State NC zip.2433Scontaa No 91D 942.434SEma6- ;oar norris 14 Si p De Ao o.CO."
*Please nn out applicant information it different then landowner �L 1 �'
CONTACT NAME APPLYING IN OFFICE:
:E--�M� I C Ynk t t_-Ln4 r�O R— �Dk4 Phone* q l o •• g92,• 4345p
PROPERTY LOCATION:Subdivision 1 RC 1 - CtP--Qt Lot if `�7 Lot Size//:..•S I
State Road Y MSQ— I�tll ii 3 State Road Name. BOLL.e W S '�._� •7p Map Book&Page:Do j V f 111
Hanel' OqoVIJ 0100 oS PIN. DOC Ci• • 3117. ODO E�
Zoning': k4'.]GFlood Zone' X Watershed- NIA Deed Book&Page 3LI1 //0147 Power Company': VIA k-F
*New structures with Progress Energy as service provider need to supply premise number from Progress Energy
POSED USE: ,..pJl�/
42x47 *Baths (� Monolithic
P (Size 7 a eedrooms:� : �Basement(w/wo bath)._Garage. 'Deck. Crawl Space:_Slab yy/ Slab
(Is the bonus room finished?(V))yes ( )no cul a closet?( )yes ( )no(if yes add in with*bedrooms)
❑ Mod'(Size x )t Bedrooms *Baths Basement(wlwn hath)_Garage'_Sac Bui!t Deck__ Cri. e.-... on Fame_
(Is the second floor finished?(.j yes ( )no Any other site built additions?( 1 yes ( )no
❑ Manufactured Home-_SW DW TW(Size x )#Bedrooms._Garage. (sile built? )Deck- (site built? )
❑ Duplex.(Size x )No.Buildings. No.Bedrooms Per Unit.
❑ Home Occupation.*Rooms- Use: Hours of Operation- *Employees
❑ AdditionlAccessonz'Other.(Size_x )Use: Closets in addition'( )yes (_)no
Water Supply V 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 hon/ .d feet(500')of tract listed above?(_ )yes (jtie
Does the property contain any easements whether underground or overhead( 1 yes ( V)no
—C
Structures(existingr propose ogle family dwellings- 1 Manufactured Homes Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum 3s Actual 1-0
Rear 2S 111WW.11 -1
p
Closest Side I0 19
Sldestreevcorner lot 20 014
Nearest Building NIA NIA
on same lot
Rnsanenhal Lana La*AapLnanon .,i 1 ai .111'11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: 13 yt-F rhW'( '4D i I v W An.p S
VAIL nalicti '-ra9-rJ (J bWTI, CttE-ts k) �t �tt+ 12-D c&o to
3-(St-L- 1V.f 5 RV `t't)N-rJti. SU '6 • ow E)
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 statements en ,are accurate d correct lb best of my knowledge. Permit subect to revocation if false information is provided
�
Ignatius of Owner or Owner's Agent , Date
"9t la the owner/applicants responsibility to provide the county with any applicable information about the subject properly,including but not limited
to: boundary information,house location,underground or overhead easements,etc.The county or its employees are not responsibk for any
incorrect or missing Information that Is contained within these applications."'
"TMs application expires 6 months from the Initial date if permits have not been Issued"
rsdenoa;Lana Use FVpcanon c ,grso._ a3i1
S 1` 35' 51.0000" W 100'-0"
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Sll E PLAN APPROVAL
MSTRIC SE , '
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N 1` 37' „'-3 3/4"0.0000" E R=335'-0"
YBEDROOMS_---- '" AL-33'-9"
71
}--0 - m of
RESERVE DRIVE
CUMBERLAND HOMES, INC.
THE SHOLOM WITH 3RD CAR GARAGE
LOT * 3 THE RESERVE
SCALE: "s410'
NAME: C yG rLA-Np lic s APPLICATION k:_
*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 I CONFIRMATION#
nvironmental Health New Septic System Code 8 DD
• All property Irons must be made visible. Place"pink p roperty flags"o n each corner i ron of lot. All property
lines must be dearly 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 qrade 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 corners 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
BOO (after selecting notification permit if multiple permits exist)for En vironmental 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 Existing Tank Inspections Cod e 800
• Follow above instructions for placing flags and card on property.
• Prepare for inspection by removing soil over over outlet end as diagram indicates, and lift lid straight up(if
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 & select notification permit if
multiple permits,then use code 800 for Environmental Health ins pection. 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 { J 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.
{LYES { .� /NO Does the site contain any Jurisdictional Wetlands?
{ }YES {N'}NO Do you plan to have an irrieation sesfem now or in the future?
{_)VES { 11/NO Does or will the building contain any drains?Please explain.
t }YES ( v<1:10 Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
{_}YES {.-r 0 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 { I NO Are there any Easements or Right of Ways on this property?
{_}YES { wr<0 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 Ile Information Provided Herein Is True,Complete And Correct. Authorized County And
Suite Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I Understand That I Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site Accessible So Thai A Complete Site Eval tion Can Re Performed.
S- 3 a_ 1
PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) ATE
E Healtn Checklist ,, ct 2
tr,e
•Each section below to be tilled out Application #
by whomever performing work.
Harnett County Central Permitting
Must be owner or licensed PC Box 65 Lillinglon,NC 27546
contractor Address,company 910.693-7525 Fax 910-893-2792 wwwharnett orgpermits
name&phone must match
Application for Residential Building and Trades Permit
Owner's Name:J/�)AAm ��j, tL,k1 1D 4. o d,(,t: s ,,�l,j L Date: 31)-1 117
Site Address: -Jd. -ESERJE 1..OL Phone:—Inip •R /2 • Vatic
to job site from Lillington: t �U Wy "{0 � '-t tz ,t12. Q s F( XL.-.
.JS AA `rt.& -v..l
Subdivision: 1\-t4 _ S C E-UJ t% Lot: 3
Description of Proposed Work: NI. .S . r . It of Bedrooms: 3
Heated SF:25111 Unheated SF: Finished Bonus Room? • )ES Crawl Space: Slab: V
General Contractor Information
Gum6E2ci1"uo 1-10µ-1:s 7t. c_ Tho • 892 . 43ggS
Building Contractor's Company Name Telephone
P . o . 3oY- r/27 t> 1-1 uc 2-t 335" loan nDrFg f TS7Yatioo. "A
Address ail Address
59493
License#
Electrical Contractor Information
Description of Work p41 S.F Service Size:2On Amps T-Pole: //es No
Loesm-2 A• PAcC Ct-E4le-ic_ qlq • K99 • 5384
Electrical Contractor's Company Name Telephone
S4 (. L-CSL-4E PTL. 5 -tJPo12D Nc.. A
Address 2g330 Email Address
{2001 - U
License#
Mechanical/HVAC Contractor Information
Description of Work S • F. y
57E P e f JS014 s (-FEhil 1.1 tr 4 A ca.__ 111 . 3 2.i • p is se
Mechanical Contractor's Company Name Telephone
313 5HIPwksH• P2 6gR.u61z uC u I A
Address 2'7571 Email Address
/ gt, 44
License#
Plumbing Contractor Information n
Description of Work N . S . F # Baths d /2
Kitour'a - sCmpan.ACT— PUrar/O1UCy9ephon A% o459
Plumbing Contractor's Company Name Tel
304 QUA ft t4at.r_a.1 tJA-y SA-nJFo2D, nit u/A
Address 27332 Email Address
c. o
License#
Insulation Contractor Information
=- N $1.4,L. *en .0Cy- -zNC 5902FAyTrr✓iur {to 119 . 772-4000
Insulation Contractor's Company Name &Address 4Let6y4f u G Telephone
'NOTE: General Contractor must fill out and sign the second page of this application.
Homeowners Applying to Build Their Own Home
Please answer the following questions Wen see a Permit Technician to determine it you quality for permit under Owners Exemption.
Questionnaire per G.S. 87-14 Regulations as to Issue of Building Permits (Memo available upon request)
1. Do you own the land on which this building will be constructed? Yes __ No
2. Have you hired or intend to hire an individual to superintend and
manage construction of the project? _ Yes _No
3. Do you intend to directly control & supervise construction activities? Yes No
4. Do you intend to schedule, contract, or directly pay for all phases of
construction work to be done? Yes No
5. Do you intend to personally occupy the building for at least 12 consecutive
months following completion of construction and do you understand that if
you do not do so, it creates the presumption under law that you fraudulently
secured the permit? -_ Yes No
J
I hereby certify that I have the authority to make necessary application, that the application is correct
and that the construction will conform to the regulations in the Building, Electrical, Plumbing and
Mechanical codes, and the Harnett County Zoning Ordinance. I state the information on the above
contractors is correct as known to me and that I affirm that I have obtained all listed contractors
permission to obtain these permits and if any changes occur including listed contractors, site plan.
number of bedrooms, building and trade plans, Environmental Health permit changes or proposed use
changes, I certify it is my responsibility to notify the Harnett County Central Permitting Department of
any and all changes.
EXPIRED P RMIT FEES - 6 Months to 2 years permit re-issue fee is $150.00. After 2 years re-issue fee
is as per rr cit fee sch ule
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Sig lure of Owner/Contra or/Officer(s) of Corporation Dale
Affidavit for Worker's Compensation N.C.G.S. 87-14
Theun rsigned applicant being the:
General Contractor Owner Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s), firm(s) or corporation(s) performing the work
set forth in the permit:
Has three (3) or more employees and has untrained workers' compensation insurance to cover them.
Has one (1) or more subcontractors(s) and has obtained workers'compensation insurance to cover
Has one (1) or more subcontractors/el who has tneir own policy of workers compensation insurance
covering themselves.
Has no more than two (2) employees and no subcontractors.
While working on the project ter which this permit is sought it is understood that the Central Perm ining
Department issuing the permit may requhe certificates of coverage of worker's compensation insurance prior
to issuance of the permit and at any time during the permitted work from any person, firm or corporation
carrying out the /� ,work. _./)
Company or Name: '150- Ul0 140 AAA:-S -Thu C-
Sign w/Title'- 2
/��� Date- 3I 1 1