DOCUMENTS Initial Application Date:y I `I' I Application# 1 11S /
COUNTY OF HARNETT DEMOLITION APPLICATION
108 E. Front Street, Lillington, NC 27546 Phone: (910)893-7525 Fax:(910)893-2793 www.harnett.org/permits
Land Owner: /j,4/�714 �/{/1ta_- /%,, Mailing Address: -�r.1 '4!/1 ,ter d,5 Xe;
City: tin/lei/lC�/ State' / Zip:pZ,23S.6Home#: t'77- ago '9Contact#:
APPLICANT*: A//e,it CM/re--4 Mailing Address: J% /7///l to este /1 tato
City: State: Zip: Home#: Contact#:
*Please fill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: /14//1/7 a��� Phone#: 5'/o y9 7 A7.SOS
PROPERTY LOCATION: Subdivision: � / Lot Acreage:
State Road#:ok+ W/ /�
State Road Name: �7 U �QS 41, ofc�
Parcel:.0- bSSS ID/17 PIN: VS54_' G— a'7So 'CO Zoning:} oZFlood Zone:)Y ear
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: /I fr/7y Isii¢y YO/ - 7�j',c5 J !�i q�f
nit/ I/e { /?e..40-)705 ��t( 04e� Rr�. /int, /c. r✓R,J Lei f C 7
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Structure(s)to be demolished & removed: Single family dwelling Manufactured Home Other(specify)
Structures(existing and/or proposed):Single family dwellings Manufactured Homes Omer(specify)
Water Supply: (_County ( ) Existing Well
Sewage Supply: (v) Existing Septic Tank (_)County Sewer
•If a new structure is to be replaced on this lot, please ensure that existing septic system is not damaged.
•If an existing well is on site and is to be discontinued, please contact Harnett County Environmental Health for assistance.
'Upon the issuance of the Certificate of Compliance, the Harnett County Tax Department shall be notified of the removal to
ensure proper listing.
'The demolition contractor is responsible for submitting verification of proper disposal prior to the Final inspection.
**PLEASE NOTE"Failure to completely demolish, remove,and clear the premises will result in the withholding of the Certificate
of Compliance. Thus,future permits for the property will be denied, and fines may be imposed for failure to complete demolition/
removal.
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 stale that foregoing statements are accurate and correct to the best of my knowledge. Permit subject to revocation If false information is provided.
Sign
4902224-2aleicS 1/4
Sten ure of Owner or Owner's Agent Dab
"This application expires 6 months from the initial date If no permits have been issued"
S:Planning and Inspections Flles1FORMSICP Forms
Asbestos requirements are applicable if the occupancy use is or changes to Commercial (not residential),
or if multiple structures are being demolished & removed at one time.
•
An Asbestos Inspection Report prepared by an N.C. Accredited Asbestos Inspector must be provided with application to
demolish any building including residences demolished for commercial or industrial expansion or structures. It is the contractor's
responsibility to properly notify the Department of Health and Human Services Division of Public Health — Health Hazards
Control Unit at least ten (10) working days before the demolition is to begin whether or not the building is known to contain
asbestos.
I hereby certify that the information on this application is correct and that afl work in connection with the above
referenced job will be performed under my supervision and that such work complies with the requirements of the NC
State Building Codes and applicable Harnett County Ordinances. Call for Inspection at proper stage of work.
CONTRACTOR/APPLICANT DATE LICENSE NO. (If applicable)
Please contact the Department of Health and Human Services for their requirements and permit information.
http://www.epi.state.nc.us/epilasbestosiahmp.html
SPlanning and Inspections Files\FORMS\CP Forms
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Bldg Insp scheduled before 2pm available next business day.
Application Number 17-50041157 Date 4/17/17
Property Address 58656 *UNASSIGNED
PARCEL NUMBER 12-0555- - -0187- - -
Application type description CP DEMOLITION RESIDENTIAL
Subdivision Name
Property Zoning PENDING
Owner Contractor
DARCH RALPH & SHIRLEY B OWNER
345 WILL LUCAS ROAD
LINDEN NC 28356
(910) 497-2508
Applicant
DARCH RALPH
345 WILL LUCAS RD
STAR NC 27356
(910) 497-2508
--- Structure Information 000 000 DEMO FLOODING HOUSE
Other struct info PROPOSED USE DEMO SFD
Permit RESIDENTIAL DEMOLITION PERMIT
Additional desc .
Phone Access Code . 1187178
Issue Date . . . . 4/17/17 Valuation . . . . 0
Expiration Date . . 4/17/18
Special Notes and Comments
T/S: 04/17/2017 09 : 58 AM JBROCK ----
348 WILL LUCAS RD
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call: (910) 893-7525 Fax: (910) 893-2793
Bldg Insp scheduled before 2pm available next business day.
Page 2
Application Number 17-50041157 Date 4/17/17
Property Address 58656 *UNASSIGNED
PARCEL NUMBER 12-0555- - -0187- - -
Application description . . CP DEMOLITION RESIDENTIAL
Subdivision Name
Property Zoning PENDING
Permit RESIDENTIAL DEMOLITION PERMIT
Additional desc .
Phone Access Code 1187178
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
999 179 C179 C*BLDG FINAL _/_/_
999 131 R131 ONE TRADE FINAL / /_
999 820 2820 PZ*ZONING/FINAL INSPECTION _/ /_