DOCUMENTS Initial Application Dare:_`nI do j I i Application k I 1 SMO Li I(_t71 .
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street Lillinglon,NC 27546 Phane:.(910)893-7525 ext2 Fax:(910)893.2793 ww.vbamettorg/permits
nA RECORDED SURVEYU- MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHENSUBMIITING A LAND USE APPLICATION"
LANDOWNEC�e[ N\AU T\tI.A%A.y ryry. Mailing Address: 3% t",\\\tin ,.Cr\ l � 1�04 -Ye r
city: �curT Inn State:e•rX Zip: 9"137_Contact No:%C)-5V4,-SS57 Email.
APPLICCAA�N.T'�/f&.. VV\ofttAQ 1 Mailing Address. v./1^lk ��y\�, Wim\OAILAInfJ� 1
OM' �A LAX d\ Stale I Nc2ip.a pntact NOcktpjaC% all:
'Please fill out applicant information If different than lllaardNowier •
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CONTACT NAME APPLYING IN OFFICE: \69 2 Phone k cl,�^`l+1La r- 2, S 1
PROPERTY LOCATION:Subdivision. ���-JJJJ ' "� 1 1 Lot f' CI Lot Size: • CI aI G C
State RoadP�((k]] [y COtate Road Name
�ryT^LT'T-ort W{AL/n Map Book 8 Page. ?[4'^' / p 5 0
Parcel b G5t4 I 01 Li tJ iaO AN-ac 17-63-14(D , One' 1 T' ��.L,,�, r�
Zoning Zone: ' Watershed:j.i ' Deed Book&Page. 0� Power Company': cs...I\4A\ 84-cif t C
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monahai<
❑ SFO:(Size x )f Bedrooms.___f Baths Basemengwlwo bath)._Garage:_ Deck:_Crawl Space. Slab:_Slab:_
(Is the bonus room finished?(__)yes ( )no w/a closet?( )yes (_)no(N yes add in with•bedrooms)
❑ Mod (Size x___ )/4 Bedrooms_ f Baths_ Basement(w/we hath) Garage: Site Built Deck: On Frame Off Frame__
��// (Is the second floor finished?( )yes ( )no Any other site built additions?( )yes (_)no
XManufactured Home_SW VDW TW(Size2widx LLL)k Bedrooms..3 Garage: (site built?. )Deck: (site butltn )
O Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit.
❑ Home Occupation:k Rooms. Use. Hours of Operation: #Employees.
❑ Addition/Accessory/Other(Size x )Use. _ Closets in addition?()yes ( )no
Water Supply: J County Existing Well New Well of dwellings using well )'Must have operable water before final
Sewage Supply New Septic Tank(Complete Checklist) V 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(500')of tract listed above?( )yes (Y)no
Does the property contain any easements whether underground or overhead(_)yes (4044i
Structures(existing l' " .'k Single family dwellings ( Manufactured Homes Other(specify):___
Required Residential Property Line Setbacks: Comments:
Front Minimum Actual (ftCt
Rear
Closest Side 151 -_
Sideatreet/corner lot r-'�
Nearest Building 1.0 13
on same fol
Residential Land Use Application Page I of 2 03111
APPLICATION CONTINUES ON BACK
SPE IFIC DIRECTIO 0 THE PROPERTY FROM LILLINGTON: 21 VIOLA iU>LYd 70\v.scAr y,�\�
aC,o vex . co aFaytkI 1p +
If permits are granted I agr• onform to all ordinances and laws of tie State of North Carolina regulating such work and the specifications of plans submitted.
hereby state that fofegol 1 men ar actor and correct to the best of my knowledge. Permit sue dt g m rev don if false Information is provided.
r r 11 X11111 I11
Ignature of er or Owner's Agent Dale
"It Is the ownerlapplicAnts responsibility to provide the county with any applicable Information about the subject properly,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**
Hesiaenlial Land Use Ape I'r,alinn Page 2 of 2 03/11
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SITE PI MU APPRMAI
DISTRICT Alc).C1VIJSE
IBEDROOMS--.1—
r7 eal
LP POP—
:: Date zoning Aa IMF
NAME:OIo� '0 o \`Areq— APPLICATION#:
*This application to be filled out when applying fora 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 I CONFIRMATION#
Environmental Health New Septic 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 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 Ova after confirmation. $25.00 return trio fee may be incurred
for failure to uncover outlet lid.mark house corners and orooertv 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 (alter selecting notification permit if multiple permits exist) for Environmental Health inspection. Please note
confirmation number given at end of recording for oroof of request.
• Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
Environmental Health Exist/na Tank Insoecilons 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
• Alter 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 desire system ty eosr. can be ranked in order of preference.must chose one.
1-1 Accepted IJ Innovative (_I Conventional I ) Any
1—I 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 thea swer is"yes'..applicant MUST ATTACH SUPPORTING DOCUMENTATION:
IjYES I NO Does the site contain any Jurisdictional Wetlands?
1—I YES ILIINO Do you plan to have an irrigation System now or in the future?
I__I YES I ali Does or will the building contain an)drains'Please explain...
I__[YES 1 I NO Are there any existing wells,sprinp. waterlines or Wastewater Systems on this property?
1 IYES I./(NO Is arty wastewater going to be generated on the site other than domestic sewage?
1 I YES IYI y0 Is the site subject to approval by arty other Public Agency?
f—I ES I__I NO Are there any Easements or Right of Ways on this property'?
Y
I ES I-_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 It'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 Count. And
Slate Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I Understand' hal I Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The c.• 'IMik
1 I at A Co plate Site Evaluation Can Be Performed. ^�
PR V I NERS O WNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/1(1
HARNETT COUNTY HEALTH DEPARTMENT N° 10990
ENVIRONMENTAL HEALTH SEC ''ON
°
°
OPERATIONS PERMIT
'• Name: (owner) ' 1 ' r` New Installation 'Septic Tank
Property Location: SR# t 3 Q Repairs .ONitrifigation Line
Subdivision 1p"' 1/4-1/4.11s Lot# 9 1L
c TAX IDM Quadrmt
Contractor: Registration fl
0
o Basement with Plumbing: ❑ Garage: Q
Water Supply: Q Well (Public ❑ Community '.
Distance From Well: S;3 R.
Following are the specifications for the sewage disposal system on above captioned property.
Type of system: 'Conventional
�,, � Cl Other
Size of tank: Septic Mink:L_ gallons Pump Tank: gallons
1 OK
Subsurface No. ofexact length width of depth of - 07'4'
Drainage Field ditches *1' of each ditch I ft. ditches 3 ft. ditches o2__ in.
French Drain: Linear feet
�1 Date: o I S 971 ,, A —
PERMIT NO. I °t inspected by: 4n W''�
F.dvironmatW Health Specialist
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Date: Application#
PROCEDURES AND GUIDELINES FOR MANUFACTURED HOMES
�� Replacement & Removal Criteria
I, (5 t A 1cf, Ay l.11C? _,do hereby certify the following:
rint Name) ^
I. That 1 own a tract of land located on SR �" �.(.g- in an RA-30/12A-40 or RA-20R/RA-20M
district which has a functional septic tank:
2. That the existing single/douuble-wide manufaycttuu�red
homeho .is to be removed or wwaas�removed�on
• (dale)W\, \ be- t€ r • o ed 0.H! v a1 1 VV 111 Of
3. That 1 am replacing an existing single/double nide manufactured home with a single/double wide tf.... t I
manufactured home,and: �-W
4. That the replacement of this manufactured home creates_ t residence(s)on this single tract of land,
and:
5 That there will be_L manufactured home(s)on tins single tract of land and I do/do not own
property within 500 feet of this tract that contains a manufactured home.
6. The home must have a pitched roof.for a manufactured home, whether A-shaped or rounded,which
has a minimum rise(measured at the center of the home)of twelve(12)inches for every seven(7) feet
of total width of the home. (Example: A home measuring fourteen(14 ft.)in width must have a twenty
four(24) inch rise as measured from the center of the roodine to the baseline of the roof.) (See
Illustrations Below.)
24"Minimum A-Shaped 24"Minimum 7q Rounded
Roof Pitch Rise - ),�.*.. , Roof Pitch Rise .,v
♦. - r . . ...
t K•;4'-4.1 ' rte, 2C.-4212-- R "G '4,4
F...-1".“):, 14 In WidthL. .4
ri Y'.
telt
ra 4 ^asT 3 Ad.
Ft,� b w�"� 8 °'-tAv - . .,
Note: Most Rounded Roofs Will Not Meet The Roof Pitch `
Requirement As Illustrated. The Measurement From The
Peak Of The Roof To The Base Line Of The Roof Must Be
12" For Every T Of l otal Width Of The I tome. (Ex: 14'
Wide Home=24" Roof Rise)
Continued
7. The home must be underpinned,the underpinning must be designed for manufactured homes&
Stalled in good workmanship-like manner along the entire base of a manufactured home,except for
ventilation and crawl space requirements,and consisting of the following: metal with a baked—on
finish of uniform color; a uniform design and color vinyl;or brick,cinder block,and stone masonry as
well as artificial stone masonry.
8. The home must have been constructed after July 1" 1976.
9. The homes moving apparatus removed,underpinned or landscaped.
10. Select One of the Following Options Below:
CD The current manufactured home will be removed prior to the Zoning Inspection.
b. The current manufactured home is scheduled to be removed through Project AMPI
c. The current manufactured home will be removed after the final inspection has been performed and
the certificate of occupancy has been issued.(Additional Fees&Requirements Shall Apply)
*(Additional Information for Option C)Temporary approval for replacement of a manufactured home is
allowed only under the procedures and limitations stated below.
Please initial next to each item to indicate that you understand and have or will comply with as necessary.
trOit .1 )) A valid manufactured home moving permit must be submitted for the removal of the existing home located
MJ on the property.
2) A copy of a Bill of Sale or a Title Transfer of the existing home must be submitted.
3) Items 1 &2 must be submitted to Central Permitting prior to your permit issuance.
4) Property owner/agent acknowledges that due to the fact that a second zoning inspection is required,in
order to facilitate this request,a re-inspection fee in the amount of fifty($50.00)dollars shall be paid
during the permitting process.
5) Once the home has met all other zoning requirements,a temporary approval shall be granted in order
to proceed with obtaining a certificate of occupancy. From the date the certificate of occupancy is issued,
the property owner shall have five(5)business days to remove the pre-existing manufactured home.
6) Property owner/agent acknowledges that if the pre-existing manufactured home is not removed by the
specified time of five(5)business days that he/or she shall be in direct violation of the Hamett County
Zoning Ordinance. And by creating a violation of the Harnett County Zoning Ordinance shall subject
themselves to enforcement actions,penalties,and fines specified within Article XV,(Administration
Enforcement,and Penalties)of the Harnett County Zoning Ordinance. Each day the violation continues is
a separate offence and is a misdemeanor punishable by a fine not to exceed one hundred($100.00)dollars
or imprisonment not to exceed thirty(30)days.
7) Property owner/agent acknowledges and affirms that the guidelines,procedures,and requirements
associated with the replacement of a manufactured home and the penalties for creating a violation of the
Harnett County Zoning Ordinance have been explained and accepts this document as an initial notice of
violation.
lo -?D- V1
Signature . Property 0, ler Date
*By signing this form the owner/agent is stating that they have
read and understand the Information on this form
06/20/2017 13:11 9199982612 CROSSBOWS PAGE 01
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emelt CnlyrJnnumnit /aline rennl (of SI S,UU rib; i.ellinin;limy nnJ 31.01) oneh Jnv lhc,miller will ouhnl gcJ
lu die Nitwit btyhullny till l e o nth Gil' do of Ibe(mulls to Lap nut beer.paid..
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cumpleied within Ihrce(1) day.011m yuul !wow hoe beet,removed nom the lot.
Any dept Il to pun hair yr depusll k out iellulJnllt IhWly (30j days milts tenon) Ina moved,and ii le the
wnpuusilibliy of lemur, lu Icnve a forwiading riddle's,if out. nllcrlhlnly(1U)tiny Ln nnul Ibski, tiny il6lrl to
n'enrol.
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'HAYS: II,eN nlml be wild by the month onbeginning with the_,- ling , ._. Any of
. lithe lunnml woo hie lame doling 1110 Middle u(n umnllt. 1114 101111 will
Itutdmele si the tial 111the muilr nnnl Ids umnddy ICN will itj p w:lied flu Wm tuuullt. 'I'l,eneullcr, Iib ICInt
Will begin ml tit n M rimy demi" owulb nidielndl be Ileo month It,ow ullr,
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Al/1LISI'MI(N l'UI' I0119'I': LnmlluiJ may odjssl leuutl'e 'cowl nae by glv imp;Ore jeimni e Ildniy(.Ill) ploy
millet.
• 1, hell elndl be I!SCJ I'ur iu iciulial put puses wily and nu business,nmuul'ncludny,
cornrow0in, m uulawlhl ncllvily ernll Lc conducted(lies cull.
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2. , Only slmyle-lnalily Jw chine will be alit/well Icsacc nodhis hmuimllnle Ilunily.
I. NI orlle home moil be lir vet goad eundlllun mill mootuvct,by lnnrnycmmd betbra being
nacrplcrl by I'm N. •
Nu trniVCn, cattle. swine, lirwl m other nom ur trot nynnl nni,unln or ally will sir
'Ithe most be C.onl iseA
uudun¢slinnlCJ mlLlsnh nhnll be Nepl ulnen ilii, ptenllxee. 'If days mill cols nie owned, y
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5. No Wee sbnll tic elected un lull.
(i. No nuhnuubdeo ur liber ueslur vehicles shell lunmlm us lie allowed lu tenon',Ott m,y lot
(utile limn IINly (1i)days tvilhuul it valid bcemte plebe thereon.
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06/20/2017 13:11 9194982612 CROSSBOWS PAGE 02
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•
R9;:a PROMISSORY NOTE
•
$ is 5)0.u0
Dated: 5-la-'2003 , Mk-
Principal Amount
P(,,}�G�,,I, State of,'j''JO O e 4k Cgro I, w�
FOR VALUE RECEIVED,the unders--tukspriL$1 Ay, igned hereby jointly and
-b ID severally promise to pay to the order of
1� s YU ecr"f1 C 5
. the sum of
Dollars(S I d,5ba 69 .
interest
annum ofn�the unpaid balance. Said sum shall be paid)in thctlma neer rsfol owing;
thereon at the rose of(0,145.55 per
(�U( 4 PO-Nuala NA 1---IAIW 0 rigs ft?5+- fifth or 1-4,E, �\oN ..
' Pan� q S1 nA I I 0-ol 03
All payments shall be first applied to interest and the balance to principal. This note may be prepaid,at any
time, in whole or in part, without penalty. All prepayments shall be applied in reverse order of maturity,
• This note shall at the option of any holder hereof be immediately due an payable uponcthe failure to make
any payment due hereunder within 30 days of its due date. �add i f enoj i-ua par
Mo,vHs or (ids-�4 �'
In the event this note slAll bei tauli,raan plated will;e'd-a(tureey for`dollakod;, then U1d undersigneaed\ O�-
agree to pay all reasonable attorney fees and osts of collection. Payments not made within five(S)days of due date
shall be subject to a lam charge of
such address as may from time to time be designated by any holder hereofAll payments hereunder shall be made to
f.
The undersigned and all other parties to this note, whether as endorsers, guarantor or sureties, agree to
remain fully bound hereunder until this note shall be fully paid and waive demand. presentment and protest and all
notices thereto and further agree to remain bound, notwithstanding any extension, renewal, modification,waiver, or
other indulgence by any holder or upon the discharge or release of any obligor hereunder or to this nose,or upon the
exchange,substitution, or release of any collateral granted es security for this note. No modification or indulgence
by any holder hereof shall be binding unless in writing;and any indulgence on any one occasion shall not be an indul-
gence for any other or future occasion.Any modification or change of terms,hereunder granted by any holder here-
of, shall he valid and binding upon each of the undersigned, notwithstanding the acknowledgment of any of the
undersigned,end each of the undersigned does hereby irrevocably grant to each of the others a power of attorney to
• enter into any such modification on their behalf, The rights of any holder hereof shall be cumulative and not neces-
eerily successive. This note shall take effect as a sealed instrument and shall be construed,governed and ertjeatenin°
accordance with the laws of the State first appearing at the head of this note. The undersigned berels,y%e&$E LI r\,
note as principals and not as sureties. ie,
q
Signed in t fJ _e_ .
6V15 Qe� N a-> .e<s`yt ' OTggrim:
Witness/ B"V 1 .J'\R A A1/�ys'Y ti OM to j• Sae
Lii• '"d L Sn r'41 ark C $t r4,Pup g0N1`l•s,,+'�
Witness Borrower "^'n ns
Application# 1 1 L2 via.
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910-893-7525 Fax 910-893-2793 www.harnett.org/permits
Aoolication for Manufactured Home Set-Uo Permit
(Please fill out each part completely)
Part 1-Owner Information:
Home Owner Information (To be completed by owner of the manufactured 11ho� me)
Name: \ rbAirtx.e7 Address: N A\ \\ \(1:1'�fr\cV VA
City: -"CIA State: PvC Zip: r�-13V7 Daytime Phone:((1o) 5bg 8857
Landowner Information (To be completed by landowner, if different than above)
Name: Address:
City: State: Zip: Daytime Phone:( )
Part II-Contractor Information (To be completed by Contractors or Homeowner,if applicable.
Name,addres , &phone must match information on license)
A. Set-Up Contractor Company Name: unn- Sn,r 4>L,ww5 - Rnupe' iwk !A t QVP(I
Phone: CWA-q'15 3loe0 Address: 33215 QC- 1.1 ,c4cAzipat.A
City: Sprcm-c Stale: IJG Zip: A133t
Stale Lic# 34GO Email:
B. Electrical Contractor Company Name: _ )0116pN1
p nrl•;r,eZ
Phone: Address: J
City: State: Zip:
State Lic# ft,:r ct Email:
C. Mechanical Contractor Company Name:
Ph ne: Address:
Cite - -. Zip:
State Lic# Email:
D. Plumbing Contractor Company Name: Sant-wry, r'(nr�,hvz
Phone: Address: J
City: State: Zip:
State Lic# c‘).-v(M.'r Email:
Part Ill-Manufactured Home Information
Model Year: \R t% Size: 74 X le U Complete& follow zoning criteria sheet
Park Name: Lot Number:
I hereby certify that I have the authority to apply for this permit, that the application is correct including the contractor
information and have obtained their permission to purchase these permits on their behalf, and that the construction or
installation will conform to the applicable manufactured home set-up requirements, and the Harnett County Zoning
Ordinance. nd:rstand that if any item is incorrect or false information has been provided that this permit could be
revoked.
b)-,30 ' 11
Signatu e of Home Owner or Agent Dale
'Effective July 1,2004,a County Tax Deoartment Movina Permit must be provided before a Set Up Permit will be issued. It is
purchased from the tax office of the county that the home is moved from. lithe home is from a dealer,we need proof of year on the
Form 500 and if available,the serial number.
List of inspections and Egress requirements available upon request. Progress Energy customers must provide Premise Number.
SETUP 04111