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DOCUMENTS Initial Application Date- Application# I r1 S CJ''Y I I .. .3 CU#_ COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION Central Permitting 108 E.Front Street Lillington,NC 27546 Phone (910)893-]525 ext2 Fax (910)893-2793 www.harnett.org/permits "A RECORDED��SU��RVEEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION' LANDOWNER. Cu44415;11-1 rcl«v 1W#k'ri lIUL Mailing Address- Sa Wct 4.c b bsJ City. (r State: n Zi : I• Contact No: r /f ���� p Email. oQn In or n s I 457 @ yaluD. APPLICANT•: CumB6IL La-WO LIO Y�f' p co AA u��tailing Address P. 0 (SOX '7 2'7 city. hail ki State:HG zip:MSC-Contact No1RID 892•434SEmail Pleasefill out applicant information if different han landowner Irk 1 �_ CONTACT NAME APPLYING IN OFFICE: �•rM'L�Ir�C Ir Int CL Le O� -SDOC4 Phone# 9 ' 0 •(]g92..• 43 t(C PROPERTY LOCATION:Subdivision: 1 T 1 E g ._E6 n12�, t_ Lot I: -I Lot Size: •icy State Road*N('SR I l•13 State Road Name: R0 LA-INS ��yy_� ) I LI r�-� Map Book&Page 20�� I �,f Parcel: pO' oL4s 0ioo Oct PIN. 0(IAg -Sri- 123`1 . 000 An Zoning. RA'"\DFlood Zone: '` Watershed: MIA Deed Book 8 Page:3419/OI-K Power Company': Del KZ" *New structures with Progress Energy as service provider need to supply premise number from Progress Energy. POSED USE: FD'. Size rye Monolithic ( 19 x )#Bedrooms:'1 #Baths 2�Bissemenl(w/wo bath): Garage: Deck:_Crawl Spam: Slab: Slab. (Is the bonus room finished?(V)yes ( )no w/a closet?( )yes ( )no(if yes add in with*bedrooms) ❑ Mod(Size__ x_ __)#Bedrooms _*Baths Basement()Own bath) Garage Site Built Deck On frame Off Flame_ (Is the second floor finished?( I yes ( )no Any other site built additions?( 1 yes ( 1 no 7 Manufactured Home: SW_DW TW(Size x )I Bedrooms _Garage. (site built? )Deck: (site built? ) E l Duplex.(Size x )No.Buildings. _No. Bedrooms Per Una. El Home Occupation.#Rooms: Use Hours of Operation: #Employees. ❑ soAddition/Accessory/Other:(Size x I Use. Closets in addition?(_)yes ( )no Water Supply: /County Existing Well New Well(*of dwellings using well )'Must have operable water before final /New Supply: V 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 hundr d feet(500)of tract listed above?Li yes I /no Does the property contain any easements whether underground or overhead( )yes (✓))no Structures(existing o ar Single family dwellings' i Manufactured Homes- Other(specify): Required Residential Properly Line Setbacks: Comments: Front Minimum 35 Actual 1IQf if Rear 2S QQt.( 9 Closest Side I 0 30 Sidestreetimmer lot 70 "II li- Nearest Building N IA A on same lot Residenhal Land Use Application Pee:, '• APPLICATION CONTINUES ON BACK SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: 114-ICE 4 0 I t o W^R.Q s i-u QuAl ehJ LEFT- burn CFftisnA-t./ Meer let (ro ti"pPRox 8- iD YLtf2n1 Q) ONTO (ZOI.I-bis ,LD S6t6- tnl © - If permits are granted 1 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 are accurate' d correct th best of my knowledge. Permit subject to r vocation if false information is provided. ignature of Owner or Owner's Agent Date 1 "9t is the owner/applicants responsibility to provide the county with any applicable information about the subject property,including but not limited to;boundary Information,house location,underground or overhead easements,etc.The county or its employees are not responsible for any Moonset or mining information that is contained within these applications."' "This application expires 6 months from the initial data if permits have not been issued" Pna.nenc ai I a -Use Aupticalion ]3l11 UI N 18` 17' 7.0000" E 227'-9 13/16" 80 LAw EP o m J 1/6 m m' io S 30'-0" 13, 0 6d o 17,9z0, 9E} 0. ti R-50'-0" AL=99'-3 1/8" R=25'-0" AL-21'-3/8" RESERVE DRIVE CUMBERLAND HOMES, INC. THE OAKLAND WITH 3RD CAR GARAGE LOT * 9 THE RESERVE SCALE: ¶"s40' t,i1F PLAN A(P!PRziOVVAL Com\ DiS1 RicI USE— 7 M BEDROOM', L�- a:.` 50 + ..=„e u, C=A-K.11) bA.Ae3 NAME: APPLICATION f/: *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 fE 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 p Environmental Health New Septic System Code 8 00 • All property irons must he made visible. Place"pink p roperty flags'o n each corner iron of lot. All property fines 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 al/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. 825.00 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 800 (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. E 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 8 select notification permit if multiple pe rinds, then u se code 800 for Environmental Health ins pection. Please note confirmation number plven 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 (V(Conventional {_} Any {_J 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 supportine documentation. { }YES {�va/}NO Does the site contain any Jurisdictional Wetlands? { }YES {_ NO Do you plan to have an irrigation system now or in the future? { }YES {6O Does or will the building contain any drains?Please explain. /N )YES I v NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property? { )YES }v}/I NNO Is any wastewater going to be generated on the site other than domestic sewage? {_}YES {I/}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 {V) 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 Arc 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 That A Complete Site Evaly��lion Can Re Performed. PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) ATE E-Health Checklist cf- e m 'Each section below to be tilled out Application # by whomever petlorming work. Haman County Central Permitting Must be owner or licensed PO Box 65 ellington,NC 27546 contractor. Address,company 910-8937525 Fax 910-8932793 www.harnnu.org/permiis name&phone must match /� Application for Residential Buildino and Trades Permit Owner's Name'. j ,l,t ,l�= *LEC ��tJ , rrD��ate: e4 Site Address: \�\ SC (L_VE pL.... Phone:-1 (D .R92 • (17(t5- Directions to job site from Lillington: Tkle-( k ri 140 1 'ID rt,Q5 Fw CmAN t, •rJT9 aL.. 1 rc.JLAG-14 r RtP cso tD 0L01.A-rt,IS it0 -t'�arJ Ju73. t © Subdivision: "MC 'R-ESEAUc Lot: 01 Description of Proposed Work: NI. S . 4 . #of Bedrooms: 3 Heated SF:igl I Unheated SF: Finished Bonus Room? -YES Crawl Space: Slab: V/ General Contractor Information Cu,mBela Lit1JD ..-cc ,'YN c. Ito • 892 • 43115- Building Contractor's Company Name Telephone P • 0 . '2,05e- r727 t>14-4 ( uC 2B33S oanrnprris f 457€ y4hoo. COM Address Mail Address S94g3 License# • 1 Electrical Contractor Information Description of Work r S.F Service Size:ton Amps T-Pole: Vies_No WEST # PRc.0 qjq • 4/9 • S38q Electrical Contractors Company Name Telephone 5-4 (s 1.-•C-S E D2. SA,JFoR . NC— N1 A Address 2g 330 Email Address i2-001 - L4 License# Mechanical/HVAC Contractor Information Description of Work NI . S . F. SitPkENS'osIS 1.'F'CkilflG- et tot_ 91Y • 3z9 • oa8o Mechanical Contractor's Company Name Telephone 313 5H (Pwksti• PQ 6**QJJEL Uc u A Address 2'7f2% Email Address RLa44 License# N Plumbing Contractor Information NDescription of Work • S • F # Baths 2- (Aar (Aar cm- CbwtaALT PLurw0rIJG- 919• R(>R• DIS-9 Plumbing Contractor's Company Name Telephone 304 f Ali- t{ntaatu Wk'( SMJFo20, rJc IIIA Address 2733 a Email Address 231 . 0 License# Insulation Contractor Information _- N SIn L. k'n u =-N c. 5902 FkyETrr✓iu.E {(0 119 . 77z g coo Insulation Contractor's Company Name .4 Address r.E(Ght tut- 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 then see a Permit Technician to determine if you qualify 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 8 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 ifyou 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 psrrr : sul:.tune of Owner/Contra or/Of-treads) of Corporation Date 1 / 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 1i set forth in the permit: Has thr tie (3) or more employees arta has oGtalned workers' compensation insurance to Lover them Has one (1) or more subcontractors(s) and has obtained workers' compensation insurance to cover them./ 7/Has one (1) or more subcontractors(s) who has their own policy of workers' compensation insurance covering themselves. Has no more than two (2) employees and no subcontractors. While working on the project for which this permit !a sought it is understood [hat the Central Permitting Department issuing the permit may require certificates at coverage of worker's compensation insurance prior to issuance of the permit and al any rime during the permined work from any person, firm or corporation carrying out the work. Company or Name'. CMA41-T5clr1_L--*3 ü •LA.45 S rtj e_- Sign w/Title: / Date 31Xfl \ .�t J