DOCUMENTS 4.
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Initial Application Date: l I I p I Application# I I I 11 `I
CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.hamed.orglpermits
^A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCCH�H/pA�SE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION*'
LANDOWNER A I C lc 4 '( c)FI t.IC c�(� Nailing Address: ' i i _ — / /
City'. L, L L 14.11,%Z ! State k ZiP1Z1Contact No: SS I4 c& 4 LS 75 Email: //S'i es r..+r L,.;l. 7/r✓4,��./.e,..,
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APPLICANT': .P-- -- Mailing Address'. ✓✓
City: State: Zip: Contact No: Email:
'Please fill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: l Phone#
PROPERTY LOCATION:OCCSubdivision: L.._.Of 1� I�ca.
I Ls. Lot#: Sr) Lot Size: ,I,' C)O
State Road# SILO Stale Road Name: L.IC LYS;CLA &I//tt.,\1,s _Dr 1 Map
fBook k88lPageP P �I
Parcel. 03 DSV I 0af3Lz LAS( PIN: V�S��(U; LO -1Li '-4 / 8 /• oot�.
Zoning^ bod Zone: k Watershed: Deed Book&Pag3U l3$5 Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: Monolithic
❑ SFO:(Size x I*Bedrooms:_#Baths: Basement(wlwo bath):_Garage:_Deck:_Crawl Space: Slab: Slab:
(Is the bonus room finished?( )yes ( )no wl a closet?( )yes ( )no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms_#Baths_Basement(wlwo bath)_Garage:_Site Built Deck._ On Frame_Off Frame_
(Is the second floor finished?(_)yes (_)no Any other site built additions?(_)yes (_)no
U Manufactured Home:_SW DW TW(Size x )#Bedrooms._Garage. (site built? )Deck: (site built? )
❑ Duplex.(Size x )No.Buildings: No.Bedrooms Per Unit.
*Employees.
LI Home
Home Occupation.#Rooms: Use. \ Hours of Operation:
AAdtlitionlAccessorylOthec(Size /�x WI.)l Use. lL� LI( Closets in addition?(_)yes (_)no
/Water Supply: ✓County Existing Well New Well(##of dwellings using well )'Must have operable water before final
Sewage Supply. New Septic Tank(Complete Checklist) S/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
Does the property contain any easements whether underground
_oroverhead(_)yes (_)no
Structures(existing or proposed)' UST
.Single family dwellings Manufactured Homes'. Other(specify): ' \A'C PCo."4-
I^e
Required Residential
Property Line Setbacks: Comments: VVV �'-C ^.tom
Front Minimum 0.� Actual
Rear 1S k4(0-1"'
Closest Side \a
SidestreeUcorner lot
Nearest Building
on same lot 03/t t
Residential Land Use Application Page 1 of 2
APPLICATION CONTINUES ON BACK
SPECIE DIRECTIONS TO THE PROPERTY FROM LILLINGTON: 7 'T6 t-. 0 t s 12 C 4o
CLv La% N ih it f LS
If permits are granted I agree to con m all ordinan d laws State of North Carolina regulating such work and the speafications of plans submitted.
I hereby state that foregoin state n re accurate d rr o the best of my knowledge. Permit subject to on if false information is provided.
nature o Own or ner's Agent Date
•
II
*telt is the ownerlapplicants responsibility toprovide the county with any applicable informationabout the subject property,including but not limited
to:boundary information,house location,underground or overhead easements,etc.The county or its employeesare not responsible for any
' incorrect or missing information that is contained within these applications.'"
"This application expires 6 months from the initial date if permits have not been issued"
•
Residential Land Use Application Page 2 of 2 03111
PRELIMINARY PUT NOT FOR RECORDAUON, SALES OR CONVEYANCES.
Is-' 1. MS PUN B FM WCA1Y1 PURPOSES ONLY.
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COLONIAL HILLS DRIVE •.I'
60' R/W ,' Q�
GRAPHIC SCALE -SITE PLAN FOR-
-10 0 30 m 120 R t R ENTERPRISES OF FAYEIT'EVILLE, LW
NM MI MI EIN • 111AUB0lVSJON - COLONEL HILLS SUBDIVISION
N I1CA/t,.• PRASE TRUE NAP Mood-vis
( IS TELT ) %%N11-*.c•; I - PIN O608-14-4787.000
1 inch - BO IL ;2,t 1.M.
BARBECUE TVP _ •EAL •1 eel.Ain mak MS lib Oa..•,.,rW•r
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HARNETT COUNTY mo•N N NA anis
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NORTH CAROLINA • ' Yty y�_ m'•'�"'Ib Yidrti-1----•r
fi�t1"� S`�tt�RTi_—M• w___a �I nal slam Os balm Ms
DATE-JAN. ll, 2007 %.'y ""' AMini°es SS u 47-3 •w-w�'
SCALE- I' = 60' �e.� L.AIT.11L w r r Si r Nb 1211•2228 r AIL IVA
CATHY L. AUTRY, PLS 3796
3948 A SUNNYSIOE SCHOOL ROAD /I o �' �""
PHONE IALL1 NC -553 k; tU 4C, r1w1.3
FAONE - (LE, 213312
8 136 b*r Aar1 iiiLLLLu lww U
NAME: err r CU't-en S( . APPLICATION#:
"'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 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
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.
Environmental Health Existina 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 (it
possible) and then put lid back In place. (Unless inspection is for a septic tank in a mobile home park)
• DO NOT LEAVE UDS 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.most choose one.
} Accepted I_I Innovative {_} Conventional 1I Any
I } Alternative j—I Other
The app 'cant shall notify the local health depa ent m in submittal of this application if any of the following apply to the property in
question. If the answer is"yes",applicant M .T ATTA 'H SUPPORTING DOCUMENTATION:
( IVES [_I NO Does the site co ain any Jurisd -bona'Wetlands'!
I_IYES {_I NO Do you plan to ave an irrigation 'ystem now or in the future?
}YES (_I NO Does or will e building contain a y(rains'!Please explain.
{_IYES I NO Are there a{y existing wells,spring. waterlines or Wastewater Systems on this property'?
I—}YES } NO Is any wa ewater going to be genera{* on the site other than domestic sewage?
I—}YES I I NO Is the sit' subject to approval by any oth'r Public Agency?
(_}YES { I NO Are th- e any Easements or Right of Ways n this property?
IYES I_ NO Does e site contain any existing water,cable, *hone or underground electric lines?
If y s please call No Cuts at 800-632-4949 to loca the lines. This is a free sere' e.
I Have Read This Ap Oration nd Certify That The Information Provided Herein Is •• Complete An• 1 rtrert. Authorized County And
State Officials Are Gra • gilt Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I Understand Thall Am Solely Res nsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Sit Ace a So That A m ere Site Evaluation Can Be Performed.
PROPERTY OWNERS 0 NERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
• 10/10
OW09111 Application#
Harnett County Central Permitting
• PFBox 0893glon NC 276e8
Each mean below to be hied out
by whomever palms p work 910 883 7525 Fax 870 883 2787 www hornet wypermM
Must be owner or Iwemed
cenlradon Address company poolicatbon for Residential Buddma and Trades Permit
name a phone must match
OwnersName �AdZ2Y /11U'/Ne-ti �1- �t Date 41-/R-/ 7
Site Address 9 Cp Ce$Lrct i AZ- ALL 5 hiz Phone IF/ 9L (0.5-9?
Directions to pb site from Lillington
Subdivision Lot
Description of Proposed Work #of Bedrooms _
Heated SF Unheated SF Finished Bonus Room9 Crawl Space _Slab
General Contractor Information
Budding Contractors Company Name Telephone
Address Email Address
>uJcue
License#
Electrical Contractor Information
Description of Work Service Size Amps T-Pole _Yes No
Electrical Contractor s Company Name Telephone
Address Email Address
License I
MechamcalIHVAC Contractor Information
Description of Work
Mechanical Contractors Company Name Telephone
Address Email Address
License I
plumbing Contractor Information
Description of Work #Baths
Plumbing Contractors Company Name Telephone
Address Email Address
License#
insulation Contractor Information
Insulation Contractors Company Name 8 Address Telephone
*NOTE General Contractor must fill out and sign the second page of this application
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 Hames County Zoning Ordinance I state the intonation on the above
contractors is correct as known to me and that yv swnma below I have obtained all subcontractors
permnawn to obtain these Demote and if any changes occur including listed contractors site plan
number of bedrooms building end bade 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 PE IT FEES-6 onths to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is as r c nt fee ached
Signatu of Owner/Contr r/Officer(s)of Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The undersigned 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 obtained workers compensation insurance to cover them
Has one(1)or more subcontractors(s)and has obtained workers compensation insurance to cover
them
Has rte(1)or more subcontractors(s)who hes their own policy of workers compensation insurance
coven mselves
✓/Has no more than two(2)employees and no subcontractors
While working on the project for which this permit is sought it is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of workers compensation insurance pnor
to issuance of the permit and at any time dunng the permitted work from any person firm or corporation
carrying out the work
Company or Name /-
Sign w/ride aLa .1 - Date 1///g//7
/I �