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DOCUMENTS Initial Application Date. LDI?3/I� Application# I 1 . 6Th 1 Iw3 CU# 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 www.harnett.orglpermits ^A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)8 SITE PLAN ARE REQUIRED APPLICATION** SUBMITTING A LAND USE APPLICATION LANDOWNER. Rebear} SCA l h Mailing Address: 45o 'Rawls r I KtJ R-, City: Cl.4 Uay -Vac, ac,rtr State: NC Zip: .21S Contact No'rail: APPLICANT': Mailing Address. City: State: Zip: Contact No: Email: 'Please fill out applicant information if different than landowner CONTACT NAME APPLYING IN OFFICE: Phone# �I Lai PROPERTY LOCATION:Subdivision: Club ,� ( Lot#'. 1 Lot Size: , /' L State Road# Li .1 State Road Name. Ra4/.JLS Club /Wt Map Bock 8 Pag ' ) / 1/ 3 Parcel: O g Ole55 bOeo sr,�� PIN: b�(.0•��51IS_I G 1 L X133 C. exit tonin b Flood Zone. 7` Watershed: Deed Book 8 Page:OCT/ D J Power Company *New structures with Progress Energy as service provider need to supply premise number from Progress Energy. PROPOSED USE: Monolithic ❑ SFD (Size x )#Bedrooms._#Baths: Basement(w/wo bath): Garage: Deck._Crawl Space: Slab: 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?( )yes (_)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 cupation#Rooms: Use: Hours of Operation: #Employees. Addition/Accessory/Other:(Size ay x 211 I)Use: Dec.K Closets in addition?( )yes X no Water Supply _County Existing Well New Well(#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 land,own land that contains a manufactured home within five hundred feet(5005 of tract listed above?( )yes ( )no Does the property contain any easements whether underground or overheadf ( )yes (_)no Structures(existing ropose . Q.�.'I ingle family dwellings: I Manufactured Homes: Other(specify) ( l-+1 bC A'r.� Required Residential Property Line Setbacks: Comments: 1 Front Minimum Actual 3 5 Rear �S— nP to Closest Side I O s &U Sldestreet/corner lot Nearest Building on same lot Residential Land Use Application Page 1 of 2 03111 APPLICATION CONTINUES ON BACK SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Li 0I Ncr 't0 Rawls C Ri M.' Urn Z. 1 • - • )0 t wit% - i 1.2C . . 7a-K. Cor0.y house- • 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 and correct to the best of my knowledge. Permit subject to revocation if false information is provided. (0/21/f7 Signature of Owner or Owner's Agent Date mit 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 LEGEND NTS NOT TO SOLE N PP EXISTING MON PIPE PAWLS CLUB RD M M WATER POLE n PS TELEPHONE BOX `�1 IPS IRON FIFE ESET R a OPAL TRANSFORMER OO = CAN ARIL 13 BOA 0 POLE MINT POLE OHR CRAHER) E CF.E.S. END SCOTCH WIPE) RCP WRECKED CONC. EVEI. B.O.C. BACK OF CURB 9 F.N. FIRE HYDRIN Orl LT. MMS CHURCH AD C\0 SEVER CLEANOUT - 6 ES DIBTRIO IRON STARE YM. $IM*CIf ga EXISTING VICINITY INP NM) P.K PMKR IC*L4im N PORCH 260 60.3 RI STORY FRAME HOUSE A �e�fe( 34.0_ 603 k N ?L BILLY JOE BRYANT INSET (NT ) �OWA °B D.8.2743. PG.337 J !g. I 14.0.2010. P0.319 .B.20111I.. P12 1,3 � I 91.9.2011. IP S 88'24'08'E 329.74' ` 3 gelliell EIP � � ' 90.6 pP �� / - INSET'fib•LD "al i OA F cant. PMPOND © 81.6 .$$.�OO� (MPROX. LCGTION) Ml iP)� 12 I 9.3' AIp,I Il B 11 01 nN C L1 5 N 8507'31'E 388.51EIP EIP M II q ES m ECM C/L BRANCH �//� -�- - _—� �N'PROX.LOC6TON) /_ ? (any $ Q HH N }Y b pp7 ENn O N 88'06 13 832.74 VI ECM JOSEPH KENT REVELS SITE PLAN APPROVAL BRENDA H. REVELS `�(� D.8.2298. P0.255 DIsTPoCT�- L'_l3b_ 5 SEc ,., L JBEDRGOM�__. __----" I�__ ���._ Coutes Bearing Distance G6Ic 1 — Znnl Ngor LI 8 88'24'08' F, 200.77' L2 N 01.96'62' E 218.97' L9 N BB°24'08' W 58.77' NOTE: SHOWN IS LOT 1 OF L4 N 01434'501 E 80.28' LOIS A. WESTER & DONNIE L. DIX S/D REF: 1.1.B.20112 P0.113 150 0 150 300 450 AREA = 6.998 ACRES i••••■iNa-a 460 RAWLS CLUB ROAD GRAPHIC SCALA - FRET NAME: 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 I CONFIRMATION# Environmental Health New Septic SvstemCode 800 • All property irons must be made visible. Place "pink properly 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. Environmental Health Existin0 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 (it 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 8 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(sn can be ranked in order of preference.must choose one. } Accepted I } Innovative I—} Conventional I1 Any II Alternative I—I 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 I } NO Does the site contain any Jurisdictional Wetlands? {_)YES I1 NO Do you plan to have an irrigatimi system now or in the future? {_}YES { } NO Does or will the building contain any drains?Please explain. IVES II NO Arc there any existing wells,springs, waterlines or Wastewater Systems on this property? I_{YES 1-1 NO Is any wastewater going to be generated on the site other than domestic sewage? I }YES I1 NO Is the site subject to approval by any other Public Agency? {_)YES I_} NO Are there any Easements or Right of Ways on this property? { }YES 1I 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 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 E aluation Can Be Performed. 1'- . - 6/21/l� PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE 10/10 09/09/11 Application# Harnett County Central Permitting PO Boa 95 LCIn61on NC 27519 Each aepasn below to be NIM out 910 893 7625 Fax 910 893 2793 rimy Smell mg/permits by whomever psdomang work Must be owner or licensed contractor Address company Application for Residential Building and Trades Pima name a phone must match Owners Name Date Site Address Phone Directions to fob site from Lillington Subdivision Lot Description of Proposed Work #of Bedrooms _ Heated SF Unheated SF Finished Bonus Room?_Crawl Space _Slab r . , .. n •r forma • Rnb ;sex:, (Selflowne,- q19 - MIS - 2363 Building Contractors Company Name Telephone 4So12nLok FtA$uay- 1/nr: nq Address NL x152.6 Email Address N1A License# glectncal Contractor Information Description of Work Service Size Amps T-Pole _Yes_No tJICl Electrical Contractors Company Name Telephone Address Email Address License# )AechamulIHVAC Contractor Information Description of Work Mechanical Contractors Company Name Telephone Address Email Address License# Plumbing Contractor Information Description of Work #Baths � l 'RC Plumbing Contractors Company Name Telephone Address Email Address License# Insulation Contractor Information 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 Dv mama below I have obtained all subcontractors permission to obtain these permits end if gay 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 Permdbng Department of any and all changes EXPIRED PERMIT FEES-g Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee is as per current fee schedule —4 l _ 6/2/ /(7 Signature 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 X Owner Officer/Agent of the Contractor or Owner Do hereby confirm under penalties of perjury that the person(s) firms)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 pnor to issuance of the permit and at any time dunng the permitted work from any person firm or corporation carrying out the work Company or Name Sign wITitle , 'd°2--- Date 6/21117