DOCUMENTS Initial Application Date: 7- Application# I r7 -7--)004IL/ 3
CU#
COUNTY OF T RESIDENTIAL LAND U5E APPLICATION
Central Permitting 08 E.Front Street,Lillington, NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)693-2]93 www.harnett.org/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OROFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER:Dakota Land Partners, LLC Mailing Address 5511 Ramsey Street, Suite 100
City, Fayetteville State.NC Zip:28311 Contact No: 910-401-5504 Email: Jeri.Elkinsamossycreekmgmt.Cn•n
APPLICANT':Dakota Land Partners, LLC Mailing Address:
City: State Zip: Contact No: Email:
M ease fill out applicant information� if different than landowner,
tr: W }} CLC_.
CONTACT NAME APPLYING IN OFFICE:Jeri Elkins Phone#910-401.5504
PROPERTY LOCATION:Subdivision: Mamie Bell Ridge Lot#: 91 A Lot Size: 0.107OCC-
State Road#1291 State Road Name: Old US 421 Map Book&Page 71)13 / JA7
Parcel: I3O(43ODI 6029 312v
.. PIN: b430 5S 39
Zoning:RA-30 Flood Zone: Watershed/,–)
Ppp\ Deed Book&Page- 307y1 O 776 Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
,l L' Monolithic
m SEEP:(Size 3H x 3t.)#Bedrooms LI #Baths: Z Basement(wMo bath):_Garage:_Deck: Crawl Space:_Slab: vf Slab:_
(Is the bonus room finished?(___)yes (_)no w/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?(J yes (J no Any other site built additions?( )yes (___)no
❑ Manufactured Home: SW DW TW(Size x 1#Bedrooms Garage: (site built? )Deck:_(site built? )
❑ Duplex:(Size x )No. Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use: Hours of Operation: #Employees:_
❑ Addition/Accessory/Other:(Size x )Use: 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(Comp/eta 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(5C0')of tract listed above?(_)yes (J no
Does the property contain aseegobments whether underground or overhead( 1 yes (1)no
Structures(existing a ngle family dwellings- 1 Manufactured Homes: Other(specifyp.
Required Residential Property Line Setbacks: Comments:
Front Minimum Actual lip
Rear I�X1.1
Li
Closest Side 1•
Sidestreet/corner lot
Nearest Building
on same lot
d LniItis, Apr l 1 . 1 .dJr I ..I'
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: ) 2/ N le a a-do Wf IIIQ Cajncf(n led
1-15l-# Q,$ Oiri US Hwyy `121 • len on (Y r1c -Jayson Or
le P4 at Man-1;e_ tell GccJe_
II 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.
hereby state that foregoing statements are accurate and correct to the b-- , my knowledge. Permit subject to revocation if false information is provided.
Signature of Owner or 0 er's r gent •ate
**It is the ownerhpplicants 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 6 months from the initial date if permits have not been issued"'
Dakota Land Partners,LW
NAME: APPLICATION#:
*This application to he filled out when applying for a septic system inspection.*
County Health Department Application for Improvement Permit and/or Authorization to Construct
IP DIE INFORMA'T'ION IN TIPS APPLICATION Is FALSIFIED,ClIANCI D,OR'DIE SITE IS ALTERED,TI1EN THE IMPROVF.MI!N'r
PIiRMI'FORAUG IORIZATION TO CONSTRLIC'f SIIAI.I.BECOME INVALID. The permit is valid for either 60 tmnths or without expiration
depending upon documentation submitted. (Complete site plan=60 months;Complete plat=without expiration)
910-893-7525 option I CONFIRMATION#
D
environmental Health New Septic SystemCode 800
• All orooertv 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.
• An 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.
u Environmental Health Existing 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 (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.
SEPTUse Click2Gov or IVR to hear results.Once approved, proceed to Central Permitting for remaining permits.
IC
If applying for authorization to construct please indicate desiavl system type(s): can he ranked in order of preference,must choose one.
I } Accepted lI Innovative ILL Conventional f—I Any
I—I Alternative I1 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:
II YES I x 1 NO Does the site contain any Jurisdictional Wetlands?
LIYES I v I NO Do you plan lo have an irrigation systeIN now or in the future'!
LIYES IxI NO Does or will the building contain may drains?Please explain.
[ 1YES 1 ti.1 No Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
I_-IYI!S I x j NO Is any wastewater going to be generated on the site other than domestic sewage?
LIYES Ix1 NO Is the site subject to approval by any other Public Agency?
1YES f x I NO Are there any Easements or Right of Ways on this property?
1-1 YES I x I NO Does the site contain any existing water,cable,phone or underground electric lines?
If yes please call No Cuts at K00-632-4949 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
Slate 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 That A Complete Site Evaluation C e Performed.
>717!1 1 PROPERTY OWNERS OR OWNERS LEGA FSENTATIVE SIGNATURE(REQUIRED) DATE
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IMPERVIOUS SURFACE AREA Nam:
CS DESCRIPTION AREA ALL DIMENSIONS, LOCATIONS AND FEATURES SHOWN ON
K THIS PLOT PLAN ARE APPROXIMATE AND ARE ONLY AN
¢ Q HOUSE w/ PORCH ARTISTS RENDITION. EXACT LOCATION OF ALL FEATURES
1,292 S.F. ARE SUBJECT TO CHANGE AND MAY NOT BE INSTALLED
CC p EXACTLY AS SHOWN ON PLANS AND/OR IN MODELS,
p PATIO/HVAC/MISC 27 S,F, PLACEMENT OF HOME, DRIVEWAY, SIDEWALKS AND
EXTERIOR FEATURES ARE SUBJECT TO MODIFICATON AS
Q U DRIVEWAY & WALKS 630 S.F. DEEMED NECESSARY BY FIELD PERSONNEL.
w e
TOTAL (PROPOSED)= 1,949 S.F.
LOT AREA = 29,152 S.F. CUSTOMER DATE
OLD us °Vet 421 7, IMPERVIOUS AREA =6.7%
S.K. 12911 7 CUSTOMER DATE
SITE WN
,C,0 WADE JURNEY REPRESENTATIVE DATE
4Jyp
VICINITY MAP
Not To Scale
SETBACKS 103 /
FRONT - 35' I / 103
SIDE - 10'
REAR - 25' I N/F NEW CENTURY BANK / N/F NEW CENTURY BANK
CORNER SIDE - 20' PB 2007 PG 256 PB 2007 PG 256
I /
S 18'38'56" W 135.00'
r 1
N Tt� W 25' SETBACK _
4tv/ YI— 7Y —N
CN • al `
r De4 u4 to 03
CO It
N o
97A - 14)
D 138.7' n 11\ -0
N
29,152 S.F. x0
i ClQ 0.67 AC cV
0
J
w I
Oz ' _ ; CJ
o
. IN
� 98A
oR
S 25'47'49" W le m49.1' w rp z
28.81' cn
TIL — - " -47.1'
S 7942'43" E 35' SETBACK
21.11' 36.0'
-160 -
07
N 18'39'05" E - 132.91'
TILDEN
. =pQROvpHOWINGTON DRIVE
300sE LJ-1 U PUBLIC RAW
•
- APPROVAL. FOR SCALING: '
c \ THIS PLOT PLAN AS PREPARED BY RESIDENTALL LAND SERNCES,
IS CORRECT AND IS HEREBY APPROVED FOR STAKING ON ME
�I A I h T,/ .. A DATE SHOWN BELOW.
CURVE RADIUS ARC LENGTH CH LEt TH CH BEARING WADE JURNEY HOMES REPRESENTATIVE DATE
Cl 25.00' 35.62' 32.68' S 59'28'11" W
THIS PROPERTY MAY BE SUBJECT TO ANY AND ALL THIS DRAWING DOES NOT
APPLICABLE DEED RESTRICTIONS, EASEMENTS, REFLECT AS-BUILT INFORMATION
RIGHT-OF-WAY, UTILITIES AND RESTRICTIVE
COVENANTS WHICH MAY BE OF RECORD OR IMPLIED. PRELIMINARY PLAT
NOT Pat RECORDATION, CONVEYANCES. OR SALER
50 0 50 HOUSE LOCATION PLOT PLAN
FOR
SCALE: 1" = 50' #15 TILDEN HOWINGTON DRIVE
RESIDENTIAL, LOT 97A, MAMIE BELL RIDGE, PHASE ONE
Upper Little River Township, Harnett County, North Carolina
IND SERVICES, PLLC. PROPERTY OF: WADE JURNEY HOMES
1500 Piney Plains Road. Suite 102 MAP BOOK 2013 PAGE 28 DEED REFERENCE
Cary, North Carolina 27518
Phone (919) 977-1554
Firm License N P-0873 DRAWN BY: E.G. I DATE: APRIL 19, 2017
09/09/11
Application#
Harnett County Central Permitting 4 Ni 3
Each section below to be filled out PO Box 85 Ltllmplon NC 27546
by whomever performing work 910 893 7525 Fax 910 8133 2793 www hemett ar9lparmita
Must be owner or licensed
contractor Address company Apgllatton for Residential Building and Trades Permit
name&phone must match
Owners Name IA)4ilt r)(3 rhL14 LltanntJ Lit Date ilkein
Site Address t5e"filet NOWy��y�•q7 -t)yt pp Phone QIG-Qui• •___
Directions to job site from Lillington ' I wit[p. JU e. (}wy Z105,17-42- L-t4 01446
5.maa'vf -fit tin -hien 0 nn £. Crtst+
Subdivision _ Maryut E I Qvin 7. Lot Q'7 A
Description of Proposed Work 5GE. #of Bedrooms LI
Heated SF 74-1C+ Unheated SF 3Q5 Finished Bonus Room? Crawl Space _Slab u
General Contractor Information
J r - . 53C,Zi2.— 56649
Building Co�tractors Company Name Telephone
33m 60Mel tot met at 64/72,d, G-p 'ii 4ayro 1 nbilaebkhasiortv 4.fhonit6
Address L7410 Email Address
�14Z42 con
License #
Elaetneal Contractor Information l/
Description of Work Ltt c4 laical -41640 i ) Service Size Z Amps T-Pole I/Yes_No
Liternai.n LLtc4 lcnt 113/t-5S-1•QOQf)
Electrical Contractors Company Name Telephone
t I I-110 L.no.54L7iW Ain t Blain
Address Email Address
Ibet ti
License#
Mechapical/HVAC Contractor Information
Description of Work tilt l/nca L A.1re"
an/Semi-A le 33G 14 I-1 Q-50
Mechanical Contractors Company Name Telephone
9D• Sox 5n CU_f$manS4 L?oil
Address Email Address
4.17 lk
License#
Plumbing Contractor Information
Description of Work PIuMb i tack t141-fit f 1 #Baths
3ail1.4 PiorroIn • z-1-76 .14AZ.1
Plumbing Contractor s CompanyoName Telephone
'-53 K Gcw.cS L4,KG PA .
Address Email Address
LOSoG
License#
on tractor In ormatio
Tt'\
15 s hc�
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 authority 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 sinning below I have obtained all subcontractors
permission to obtain these permits and if nny 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 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 schedule
//La, Qac.Jn
Signature of Owner/Contract cer(s)of Corporation Date
Affidavit for Worker's Compensation NC G S 87-14
The undersigned applicant being the /
General Contractor Owner I 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/ Lel '►4-t[L✓v
Sign wrtdle/I ita.. P nni-1-C aorrjf na V Date 011117
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 06i12i2017
Entry #: 668449
Initially filed by: wjh2013
Designated Llen Agent Project Property
Print & Post
Int;Niue,Title Imurance Company N BR 97A
15 Tilden Howingmn Br. O
nnlme:mtn brn.no.COIL Lillington,NC 27546 9.( J:4--•
Address:la W.Halite Sc.Sanc 307 Raleigl. H�C°Coanly fJ Ali
]t 21601 tEL ( '.°—
Phone:804 iV'1Sa
Property Type conlmnon:
Pm:alt-4M-5211 Please pact this notice on the lob Sac.
anvil:mmwn4Hwmnecom
1-2 Fmnil Dwelling b Suppliers and Subcontractors:
Scan this image with your smart phone to
ew this tiling.You can then tilt a Notice
Owner Information IO Lien Agent for this protect.
N]H.IIC
3.100 Battleground Ave Suite 130
Unxmbora (1
NC 2741
United Slates
Email:ndbitptµwadejumeyhameLam
Phone-919-195S654
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Technical Support Hotline:0000 b904384