DOCUMENTS Initial Application Dale: S l01 W I I r) Application# Ii Sc0`f NNS
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting ` 108``E.
Fro Street.Lillin9(�on, NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.harnett.org/permits
DLILS
A ORDEDSkU1VIY�kI,RE ORR ED(0770cER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION•'
RWynn Construction, Inc. Mailing Address:2550 Capitol Dr. Ste 105
City: Creedmoor Slate:NC Zip:27522 Contact No: 919603-7965 Email: edward@wynnconaVuct.com
APPLICANT':Edward Averett Mailing Address:2550 Capitol Dr. Ste 105
City: Creedmoor Slate:NC Zip:27522 Contact No: 918603-7965 Email: edward@wynnconstruct.com
'Please flu out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE:J. Edward Averett Phone#919 603--779665
PROPERTY LOCATION' Subdivision: Avery Pond D 1 Lot#: 7 ✓ -Lot Size: • s 8
State Road# p _State Road Name: e 1 OLS 6 br. j Map Book&�PPaagge: 204 / 201
Parcel:oe O el�5J oc2 / q PIN: 0�J- 3G 0419 a QW
ZoningER 3D Flood Zone:x _Watersheds Deed Book&Page: O it) Power Company*: Duke Energy
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: S
zJ We / Mmmlimi.
Q( SFD:(Size Y /�x 6O)#Bedrooms:? #Baths:Z• Basementeetpa bath):_Garage: ✓ Beek:V Crawl Space:_Slab:_Slab
(Is the bonus room finished?%yes „no w/a closet?( )yes ( )no(if yes add in with#bedrooms)
U Mod:(Size x )#Bedrooms #Baths_Basement(w/wo bath) Garage: Site Built Deck: On Frame Off Frame
(Is the second floor finished?( )yes ( )no Any other site built additions?( )yes ( )no
O Manufactured Home: SW_DW TW(Size x )#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: I County Existing Well New Well(it of dwellings 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 and,own land that contains a manufactured home within five hundred feet(500')of tract listed above?( )yes ( )no
Does the property contain an easements whether undergrougd or overhead( )yes ( )no
Structures(existing ••Ingle family dwellings: 1 Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks:,acComments:
Front Minimum 35 Actual �f/[4
Rear 25 I7 / A
Closest Side 10 '3•//
Sidestreevcorner lot 20
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: From HCCP right onto 210 Hwy. 3 miles, Left on 401 Hwy.for 15 miles
Left on Chalybeate Rd.for 118 mile,Avery Pond on the left
If permits are granted I agree onfor to ordinanc nd laws of the St a orth Carolina regulating such work and the specifications of plans submitted.
I hereby slate that forego' s tame a accurate orre to the be knowledge. Permit sublect to r vvcation if false information is provided.
lure of Owner wner'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 6 months from the initial date If permits have not been issued"
Residential Land Use Application Page 2 of 2 03(11
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NAME: I9AI 64.57& 7,ek _MtC - 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 l CONFIRMATION#
Environmental Health New Septic System Code 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.
0 Environmental Health Existing TankInspections 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)
• 00 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 be ranked in order of preference,must choose one.
( } Accepted {_} Innovative (Conventional { } Any
{_} 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 SUPPORTING DOCUMENTATION:
(_}YES 1/
�(} NO Does the site contain any Jurisdictional Wetlands?
{ }YES {i) NO Do you plan to have an huieation system now or in the future?
{ }YES { Does or will the building contain any 9r'itins?Please explain.
{ )YES j_Np Are there any existing wells,springs, waterlines or Wastewater Systems on this property?
(_}YES {/f NO Is any wastewater going to be generated on the site other than domestic sewage?
{_)YES {/)/N0 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 (/f 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 Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I Undersh h, I :m Solely Resp sible For The P tification And Labeling Of All Property Lines And Corners And Making
The essi So • etA Cote .vaiunti), •- United. ict/7
iiiii
R V •t' ERS OR OW 'S LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
REALTORS'
6RRl1RRnIRIAllltuae AGREEMENT FOR PURCHASE AND SALE OP REAL PROPERTY
1E
nFAVOR*North Carolina Association
of REALTORS,
This AGREEMENT,Including any and oll addenda etteohed limb)("Agreement"),hi by and between
Wen Canettuetion, Ino
a(n) NA ("Buyer"),and
(individual or State of formation end typo ofeni ty)
Lite.* Croon, LLC ,
n(n) _ Its ("Seller"),
()ndivhhml or State of formation and typo of entity)
FOR AND IN CONSTORRAIION OP THE MUTUAL PROMISES SET FORTH HEREIN AND OIliER GOOD AND VALUABLE
CONSIDERATION, THE RECEIPT AND SUFFICIENCY OP WHICH ARE HEREBY ACENOWLEDGED, THE PARTD3S
HERETO AGREE AS FOLLOWS:
Section I.Terme and Detflfone:The terms Hated below shall have the respective meaning given them ea net forth adjacent to each
tam
(a) "Preeer(v"((Addmne)Muse 1, Awry Pond
Lot 1 - 95, 67, 60, 60 and 70
Plat Reference:Lot(a) 3iA ,Blouk or Section Phase 1 ,noshown on Plot Book or Slide
1016 et Poge(e) 141-142 , _ senate ConntY,condedng or 95+/- arse.
f2 If Lia box is checked, "Property" uhnll mean that pmpetty described on EahibIt A attached hxom and incotporoted
herewith by roferwce,
(For tnfomwdon pnrposea:(1)the UM parcel number of the Property is: 0553-36-6553
end,(h)sora orall of the Properly,coudating of approximately 35 acres,is deaenbed In Deed Book
5320 ,Pogo No. 9B0 Rereett County.)
together with ell btdbDngo end improvement.thereon Lad all fixtures and upporttmocea thereto end ell personal property, if any,
itemized on BAER A.
$ 01,170,000.00 (b) "Purchase Price"shall mean the man of Oen Million, One Minted IS snooty _
Thousand ___.__. .-_.___^_._ _...,._Dnlh•.ta:
male on de following pear:
$ _. 11A R) "Emmet Milner"shall mean Whim
or terms as follows: RA
Uper tido Agreement becoming n contract in accordenco with Section 19,the Emmet Money shall be
promptly deposited in escrow with , MA (name of
person/entity with whom deposited),to he applied as pad payment of the Purchase Prim at the Property at
Ctwing,or disbursed au agreed upon undm the pmvielonn of Section 10 herein.
Page 1 of S
Thu liormJoinS approved by: STANDARDFORM 580-T
North Carolina Bar AasodeRon Revised mon
North Ceram�Anode/on ofREALTORU®, �• 07/2016
Buyer Initials Jar(O Seller Initials
,lara.ssw¢,a, 4nm�n„ave :,.xcry ” alto eµ'oamey*I Item aha"kAM RamW�.Wnruvta Priv 910-113.4141 a Amy rola
Doane}
THE NORTH CAROLINA ASSOC./MON OP REALTORS 0,INC„AND THE NORTH CAROLINA BAR ASSOCIATION MAKE
NO REPRESENTATION AS TO THE LEGAL VALIDITY OR ADEQUACY OF ANY PROVISION OF THIS FORM IN ANY
SPECIFIC TRANSACTION, IF YOU DO NOT UNDERSTAND THIS FORM OR FEEL THAT IT DOES NOT PROVIDE FOR
YOUR LEGAL NEEDS,YOU SHOULD CONSULT A NORTH CAROLINA REAL ESTATE ATTORNEY BEFORE YOU SIGN
IT.
BUYER: SELLER'
Indlvldaal Individual
11:110: Dahl;
Dote: _ .. Dote:...
Barbanel Ratty Bestows Rutty
Construcelex/, Inc._,____ Yd.0 1e C. ecu r_?SC
Tem of Entity) eine I Euffty)
Nemo:
/. 64/177)(
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Dale _�G.l_S- /42_. _ _ Dote Vf!/)p
The uoderetpxed hereby aelmonledges receipt of the Earnest Money it forth heralo end agree'to hold aid Earnest Money N
emordano*vdte the tome berets,
tm
Ey: el__._.__
Page B of
STANDARD FORM!BET
Re,l ed 7/1013
0 7/201!
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Harnett County Central Permitting /7520 Vivi/
PO Box 65 Lillington NC 27546
Each section below to be filled out 010 B93 7526 Fax 893 2793 www hornet(am/permits
by whomever performing work Gro y3
Must be owner or licensed 'I
contractor Address company Application for Residential Building and Trades Permit
name 8 phone must match
Owners Namegcfrst1 nj SNC. Date tD /
Site Address 31 -j74N6 Pr Phone 906403-M5—
Directions
0boj-7945Directions to lob site from Lillington ron //CCP r.9 k+o it()Ruh/ 3g. Its Leff oat StO/Ndy/
for Lee-oN C.hal1beafe. 2€t 'Qat. YR at:le , 4ocrr Reid"ppr .
Subdivision u t/eri &AIS Lot 6
Description of Proposed Work Nett) CONS fruit?Or✓ ,5� #of Bedrooms
Healed SF 2/P4' Unheated SF Sola Finished Bonus Room Crawl Space✓ Slab
General Contractor Information
6.)4 Lrts-Erue-t:ert nuc, 9/9 b03 . 796 S
BuildiAg Contractors Company Name Telephone
2ssb ea N+01 f. Ste /OS ereerSeo,?t 27522 edworl@4/ye9%er.es•C0st
Address Email Address /
1/62,5—
License#
Elect ca Co rac or 1 ormat o
Description of Work Neu) Cogslrtle4 tON Service Size Zoo Amps T-Pole _Yes_No
t. A. 5seksoal /T/eth- t 9/t 730- /ZS/
Electrical Contractors Company Name Telephone
92-Ltt 2ale;0h�d. 13u1soii, N2-Z5-0Lt
Address Email Address
2/ l y I
License#
echanical/ lVAC Contractor Information
Description of Work /Vets) Coostrud .O4✓
(lert:ted- Neat anus A:r 9/0 go-oho0
Mechanical Contractors Company Name Telephone
779.5gasettahePd. fs3s7
Address Email Address
/1ICzool/2 N3 tbss1
License #
plumbing Contractor Information
Description of Work �Sin/ #Baths .2. 5
/ 9/7,sso- 9133
rp to �pany 7A4
Plumbing Contractors Company Narite Telephone
31(0o-14 O,orkel. e/s rebid Alt Z7s '?
Address r Email Address
ZZ/fl—
License#
T Insulation Contractor Information
/dtu,ff -Mile/'AV 91760-D999
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 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 pv sinning below I have obtained all subcontractors
permission to obtain these permits and if my 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 Mon s to 2 years permit a-issue fee is $150 00 After 2 years ire-issue fee
is ascurrehedule / 7
,.ture of Owner/Contractor/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 corporabon(s) performing the work
set forth in the permit
r/ 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 far 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 Nam al0/1 /
AS11-41G7r,A/y-INC .
Sign w/Title //, yg 60-11
Date_ 6— /7
POST AT JOB SITE - DO NOT REMOVE
LIEN AGENT INFORMATION
EFFECTIVE APRIL 1, 2013
In accordance with North Carolina General Assembly Session Law 2012-158, Inspection
Departments are not allowed to issue any permit where the project cost is $3Q000 or more
unless the application is for improvements to an existing dwelling that the applicant uses as a
residence OR the property owner has designated a lien agent and provided the inspection
department with the required information:
NOTICE-TOOK THE LIEN AGENT-NT ,f
Lien Claimants Name: 2 Iile4Tr�JS 77e�( co..�_�A
Lien Claimant's Mailing Address: I LU • /A ye// d/ , J s?7
ka*e%94 '1/C 2-7ac/
Lien Claimant's Physical Address: /7 linart.ft ca
,/��dry C nzbawl
Lien Claimants Telephone#: _ D89- k70-
' 70— f3ra Y
Lien Claimant's Fax#: ii 1; ;- 1/97-• - V �31
Lien Claimant's E-Mail Address: 3wOW+6)ef.[211Cia(,oM
e
Description of the property (include address, lot#, and parcel identification number)
323 /Iverq &td `l r f1#D13
Contractor Name: / )li.p\A��, /J�q � �/OK rrf't-e
Contractor Address: c 3U eap! lO/ 1c
£!teged,*roor, Alt(n 225-22.Contractor Telephone# !�?_S� IS 7 /
•
Successor Lien Agent Information: In the event that the hen agent revokes its consent to serve
as lien agent or is removed by the owner, or otherwise becomes unable or unwilling to serve
before the completion of all improvements to the real property, the owner shall within 3 business
days of the notice or such event do the following: (1) Designate a successor lien agent and
provide written notice of designation to the successor lien agent; (2) Provide the contact
information for the successor lien agent to the inspection department that issued any required
building permit and: (3) Display the contact information for the successor lien agent on the
building permit or attachment thereto posted on the improved property.
Date: �44/ ��//////� ���yyy
Signed._ .�L����%va'1.GC