DOCUMENTS Initial Application Date Application � / SO vy q
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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 wwwharnettorg/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)8 SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER:Dakota Land Partners, LLC 5511 Ramsey Street, Suite 100
Mailing Address:
City, Fayetteville State:NC Zip:28311 Contact No: 910-401-5504 Email: '011.Elkins@mossycreekmgmtGomt
APPLICANT':Dakota Land Partners, LLC Mailing Address:
City State: Zip: Contact No: Email:
'Please till out applicant information if different t1h`a'n landowner,�
CONTACT N APPLYING IN _"' Elkins 910-401.5504
Phone k
PROPERTY LOCATION:Subdivision Mamie Bell Ridge Lott 3 a, p
LotSize I
State Road#1291 State Road Name. Old US 421 Map Book 8 Page: 206'7/ 254
Parcel: 130b 3001 /)629 13Y� PIN 0L3n - 51-1 - 09105
Zoning-RA-30 Flood Zone: X Watershed:PiA Deed Book 8 Page: 307.// 66 7k power Company:
*New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
,,II Monolithic
x
VI SAD:(Size 39 )#Bedrooms':'I #Baths:Z Basement(w/wo bath)'._Garage:_Deck:_Crawl Space:_Slab. ✓ Slab:_
(Is the bonus mom finished?( 1 yes (J no w/a closet?(J 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_
Os the second floor finished?U yes ( 1 no Any other site built additions?(J yes ( )no
❑ Manufactured Home:. SW_DW TW(Size )#Bedrooms. Garage (site built? )Deck: (site built? )
❑ Duplex.(Size x )No.Buildings: Nm.Bedrooms Per Unit:
❑ Home Occupation:I Rooms: Use- Hours of Operation: #Employees:
❑ Addition/Accessory/Other:(Size x )Use: Closets in addition?( )yes ( )no
Water Supply: ✓ County Existing Well New Well(#otdwellings 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 MO')of tract listed above?(_)yes (✓)no
Does the property contain any easements whether underground or overhead( )yes (✓)no
Structures(existing o reposed). ing le family dwellings: , Manufactured Homes'.
Other(specify):
Required Residential Property Line Setbacks: Comments:
Front MinimumSS_ Actual 36'2
Rear �S
Closest Side I(� 5
Sidestreeticorner lot
Nearest Building
on same lot
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: 4 2/ N / I e 1 t Lrr'O W/IIIC l..L(/Y)e/ Fu
rjcl-# onlin Us Nw L121 lef4 On (Ylo.mle Cars) con Or
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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 are accurate an cone the best of my knowledge. Permit subject to revocation if false information is provided.
(0
Signature of Owner r ner's Agent Date
"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
incorrect or missing information that is contained within these applications..'"
"This application expires 8 months from the initial date if permits have not been issued"
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Dakota Land Partners,LLC
NAME: APPLICATION#:
*Thu application to be filled out when applying for a.septic system Inspection.*
County Health Department Application for Improvement Permit and/or Authorization to Construct
II(ii IF INFORMA'T'ION IN THIS APPLICATION IS FALSIFIED,CIIANOED,OR TILE SITE IS ALTERED,THEN TIIE IMPROVINMLN'I
PERMIT OR AUTHORIZATION it)CONSTRUCT Si Al 1.BECOME INVALID. The permit is valid for either 60 months or without expiration
depending upon documentation submitted. (Complete site plan=(>ll months;Complete plat=without expiration)
910-893-7525 option I CONFIRMATION#
U Environmental Health New SeDtle 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 avfor 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 trio 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.
LI Environmental Health Existing Tank Inspections Code 800
• Follow above instructions for placing flags and card on properly.
• Prepare for inspection by removing soil over outlet end of tank as diagram indicates, and lift lid straight up (if
possible) and then put lid back in place. (Unless inspection is for a septic tank in a mobile home park)
• DO NOT LEAVE LIDS 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 he ranked in order of preference,must choose one.
L I Accepted { I Innovative {_I Conventional {_} Any
I Alternative l1 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 ATTACII SUPPORTING DOCUMENTATION:
I_lYES {_I NO Does the site contain any Jurisdictional Wetlands?
{_IVES { x I NO Do you plan to have an rre tion svctem now or in the future?
I )YF:S { x I NO Does or will the building contain any dtii ns?Please explain.
II VPs 11 NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
LYES 1-1 NO Is any wastewater going to be generated on the site other than domestic sewage?
I {YES { x I NO Is the site subject to approval by any other Public Agency?
II YES I x I NO Are there any Easements or Right of Ways on this property?
I—IVES f e I 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.
1 Have Read This Application And Certify That The Information Provided Herein Is True,Complete And Correct. Authorized County And
Slate Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliancy 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 Evaluation Can Be Performed i��/7-7//-/
^
PROPERTY OWNERS OR OWNERS LEGAL REPRESENTAT ere (REQUIRED) DATE
10/10
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09/09/11 Ape icabon#
Harnett County Central Permitting I (-13 (p
Each section below to be filled outPO Box 65 Ldlington NC 27546
by whomever performing work 910 893]525 Fax 910 883 2793 www hamett Grp/permit,
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name a phone must match
Owners Name L.JMt3Urh.ai &Mint�J L.L.C.. Date 4413111
Site Address 1I PhoneQIG• 5LCL
Directions to job site from Lillington '1 /ate, Z L0 5 " ia._ LccI Q{1-la
6.rna41nth. 414 Cyt 4-urn Q nn40 E. rest-1-64,
Subdivision _ IAOJni L SPM ttC t, Lot 'L
Description of Proposed Work 5L'r. #of Bedrooms 14
Heated SF)CRA. Unheated SF 3 to Finished Bonus Room't Crawl Space _Slab 1(
General Contractor Information
(,iu 1 c. 33&Z8Z- 3L,nc,
Building Co tractors Company Name Telephone
33 t54444‘3,000144 lit5•IFTin nf4ny'o ThIni'dzIaLkejAkngiigliome6.
Address 2.74IO Email Address
4-142.4Z. �oiv
License#
Ela meal Contractor Information /
Description of Work 4111.4f t/O6'k -(: Say/ l Service Size Z0 Amps T•Pole VYes_No
Ceti"u t tALr+intp,J 33/f-561-I•QOQn
Electrical Contractors Company Name Telephone
I l ilia I L T70.54L9d0 Punt n4levt /-IZI
Address J Email Address
License d
Mechgrtcal/HVAC Contractor Information
Description of Work LILA l/ns L Air
!.nrnQ,r+Air 33G4-14u G73a
Mechanical Contractors Company Name Telephone
9 D. Om( 5n C tavmans, 2.7 o l7
Address Email Address
LI7 IR
License#
Plumbing Contractor Information
Description of Work QI(UMbt viS 111S4•oJI #Baths
i3 k4 PloMk?tnq G 33G • - 76 •nn1Z)
Plumbing Contractors Company-Name Telephone
L153K £ ant L4,1/-G ED .
Address Email Address
License #
Insulation Contractor Information
� 1 rLars T..nul Crk-
Insulation Contractors Company Name&Address Telephone
*NOTE General Contractor must fill out and sign the second page of this application
I hereby certify that I have the authonty to make necessary application that the application is correct
and that-the construction will conform to the regulations in the Building Electncal 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 by sranina below I have obtained all subcontractors
permission to obtain these ',emits and if ytry 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 Hamett County Central Permitting Department of
any and all changes
EXPIRED PERMIT FEES-6 Months to 2 years permit re-issue fee is $150 00 After 2 years re-issue fee
is as per current fee schedjde
Q04i Utetri
Signature of Owner/ContractortCcer(s)of Corporation Date
Affidavit for Workers Compensation N C G S 87-14
The undersigned applicant being the /
General Contractor _Owner V Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of penury 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 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 is sought it is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of workers 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 (Ali U-t//__ 1.
•
Sign wfrida/I (US �' (2001 4 -Con ,
ti rnatr Date (ii1of1'
11
DO NOT REMOVE!
Details: Appointment of Lien Agent Flied on: 06/12/2017
Entry #: 666027 Initially filed by: wJh2013
Designated Lien Agent Protect Property
Print & Post
Investor.Title Insurase Company MAR 73
225 Tilden Howingion Dr. 0 •O
Online:nnw.l ien.nc.nnt Lin -.
sin ton.FC 2754M1
Adams:w W Hargc::St.Suite 5T Raleigh Harnett County
'5C 27601 1:1:1a4. f
Peon:sMX640.1)ss
Prop•rty TVP• Con tenon:
Fn:vGaxaL'7I Please post his notice on the Job Site.
Emil:ernagieetiataair iO1° I-2 Family Dw ening Su ppIien and Subcontractor.:
Scan this image with your smart phone to
view this filing.You can then file a Nonce
Owner Information
to Lien Agent for this project.
NIH,LLC
3301)Battleground rave Suite 230
Greensboro. NC 29410
United States
Email:trabitcgwadeium ryhomes.eom
Phone:91V-995-5n54
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Technical Support Hotline:IXXXI n90.7384