DOCUMENTS Initial Application Dale: L,o I ((p I I ' / Application# 1 SOO° I WS l
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext2 Fax:(910)893-2793 www.harnett.org/permils
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER:Wynn Construction, Inc. Mailing Address 2550 Capitol Dr. Ste 105
City: Creedmoor Slate:NC ZIp.27522 Contact No: 919603-7965 Email: edward@wynnconstrucicom
APPLICANT:Edward Averell Mailing Address:2550 Capitol Dr.Ste 105
city: Creedmoor Slate:NC Zip:27522 Contact No: 919603-7965 Email: edward@wynnconstrucLcom
'Please fill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE:J.Edward Ave/ell Phone#919 603-7799665
PROPERTY LOC❑ATIIO�W Subdivision: Avery Pond p (� Lot#: ✓ _Lot Size'1.37
Slate Road# 1. { J State Road Na�m7e:_ IO4&- b11 . .�/� Map Book&Page:�/L/ LO/
Parcel: �r,09065-3 1002 /. ,Ci PIN: O(0s7J�efsP
Zoning: 2.h30 Flood Zone: Y Watershed/1/4w)f Deed Book&Pag0SI6 / 7b4Power Company': Duke Energy
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
�JCOI✓ Mm: _.
SFD:(Size-.50 SOO)#Bedrooms:? aBaths:1_Basement/tiyvo bath):_Garage: ✓ DSC Crawl Space:YSlab: Slat
(Is the bonus room finished?i res no w/a closet?( -- yes ( )no(If yes add in with#bedrooms)
O Mod:(Size x )#Bedrooms_#Baths_Basement(w/wo bath) Garage: Slle Built Deck:_ On Frame_Off Frame
(Is the second floor finished?( )yes f )no Any other site built additions? yes (_)no
❑ 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:
O 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 beforefinal
Sewage Supply: ✓ New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) _County Sewer
Does owner of this tract of land,awn 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 or overhead( )yes ( )no
Structures(existing orropoaed Single family dwellings: 1 Manufactured Homes: Other(specfy):
Required Residential Property Line Setbacks: . Comments:
q7
Front Minimum 35 Actual_✓
Rear 25 Lig
�/
Closest Side 10 /2-,
Sidestreel/corner 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 1/8 mile,Avery Pond on the left
If permits are granted I agree onlor to ordinanc nd laws of the St a orth Carolina regulating such work and the specifications of plans submitted.
I herebyslate that fore of/j,�y�rlteme accurate rre to the be knowledge. Permit sub/lased to rr9v��QQ alien If false information Is provided.
tura of Owner wner's Agent Date
A,
"'It 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 03111
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NAME: /N 5..N,Sf/Leriest ate_ - 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 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 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 Ild 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 be ranked in aider of preference,must choose one.
{_} Accepted LI Innovative 12-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 answeranis"yes",applicant MUST ATTACH SUPPORTING DOCUMENTATION:
{_}YES (ENO Does the site contain any Jurisdictional Wetlands?
{_}YES (7/NO Do you plan to have an privation system now or in the future?
{_}YES (jj tl Does or will the building contain any&Ija?Please explain.
( )YES ( )N) Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
{_)YES ( }NO Is any wastewater going to be generated on the site other than domestic sewage?
{_)YES (/NO 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 {ZNO 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 Underst h 1mSolely Resp stile For The P' tification And Labeling Of All Property Lines And Corners And Malting
The a se Sfr
o at Co ate ' milord' ormed, / 7
RTY ERS OR OW S LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
09/09/11 Application #
Harnett County Central Permitting
PO Box 65 Lillington NC 27546
Each section below to be filled out 910 693 7525 Fax 910 893 2793 www harnelt ism/permits
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name&phone must match ''--\\ /^�
Owners Name cI IJ.J n LDkS eta.stet rNC. Date e' —/
Site Address 179y/fieryr� at f/r Phone 9/9bOj-29(rS
Directions to lob site from Lillington/fiery
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for icMrte'tr Lefto, CNalvbei e_ 24 for YRN;tet Auer,/i Po.•f�dnnt lea
Subdivision Adery &.ddl Lot 3 7
Description of Proposed Work New l.0al fraC1en/ — ,5/ID #of Bedrooms V
Heated SFZ°L/ Unheated SF 12-4 Finished Bonus Room? Crawl Space VP Slab _
General Contractor Information
Wynn Cotkci uet"eti Zue. 9/9 /003 . 7766-
BuildiAg Contractors Company Naive Telephone
2-S-S0 'a N-fol Ik. Ste /0s rec atec 27C22 Pdubrl�/�/ya�fw�es•Cat
Address Email Address /
q z9S
License #
le t cal Co trac oInformation
Description of Work New) CO/ /rite ;OA/ Service Size ZOO Amps T-Pole _Yes_No
t. A. Taiekso Al E/mfr:& 9/7 730- /Z57
Electrical Contractor s Company Name Telephone
92-b1 Pak;qkd. 13utsod ,NC 2-751D'f
Address Email Address
ailyN
License#
Nteehamealllll{,VAC Contractor Information
Description of Work Nett) COALS fr!(Ct Oid
Cer+.Cre - kat e./dd A :r 9/0 fa-de000
Mechanical Contractors Company Name Telephone
7?9,$atfsettakePd. Jeaber3idyaNC 1$36-7
Address Email Address
A/tzeoz/2 $3 & u1
License#
plum in Contractor Information
Description of Work aid #Baths .2. .6-
1ra7ts k ta9/9,6-4-0- 033Plumbing Contractors Companyr�, Nate Telephone
31/00-4 OnarPd. (!/ayfag Nt- Z7cZ'7
Address Email Address
Z115 2-
License#
insulation Contractor Information
Tatum .-.Asa/zt a1I 9/? 10&/-614/99
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 Harnett County Zoning Ordinance I state the information on the above
contractors is correct as known to me and that by signing 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��y��y -6 Mon s to 2 years perms e-issue fee is $150 00 After 2 years re-issue fee
is as p curreEEEEEEhadule 7
i tura of Owner/Contractor/Officer(s)of Corporation
CDale
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 forthtin the permit
b--- 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 worker s 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 n
Company or Nam i'AA LD.a/671"e grail/—kit . // /� • / /7
Sign wrtitle U.� ( Ldn'rcr. Date (0 - / /
DO NOI REMOVE!
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