DOCUMENTS Initial Appecalion Date:_ ^ /a 0 i i r--'I
Application II ��11
; l6 rl.SL � ; !
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION CUP
Central Permitting 108 E.Front Street,Llllinglon,NC 27546 Phone:(910)893-7525 ext2 Fax:(910)893-2793 www.harnett org/permits
"A RECORDEDCASURVEY MAP,RECORDED DEED(OR (OFFER TO PURCHASE)8 SITE PLAN ARE REQUIRED,WHEN�SUBMITTING A LAND USE APPLICATION"
LANDOWNERJtrT d.Ja</p') Chi S•lif,EEfrI�y1L)I1 Mailing Address. P.0, Lica[ (2 5
city: B Lie 5 Cretk`7 /� (� slate:. ZIpo-751I(0r/contact No: CI i'1 Q-31'q Email:rh(is+ir(Nix ie1(OSbrQujb corn
APPLICANT': l C'1 V LL Mailing Address:
City. Stale:_Zip: Contact No: Email:
'Pease fit out aprecant IMomutlon if dmerent man landowner `[`Y' J(//� 1v j��i I,, y- I '
CONTACT NAME APPLYING IN OFFICE: 'O )„ill ' ` ✓v(bol oUah Phone# gig-5 a-q—OS(0Li
PROPERTY LOCATION:Subdivision: 1-10 1 n a Stint 6[11 t/I S I n ii Lot N: Lot�Size: J D � /7�
Slate Road# State Road Name: Sher) TT it I�LI /Sbf��1Rco /�Map Book B Page:i2.01(.0/ SYL)
Parcel (p�I��L 1'LP I r 01 3 I PIN: Wit l �U Ia' f- OtY.IY . O06
Zoning:FA-4° Flood Zone: Watershed: Deed Book 8 PageSg5)-j Or LI Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
mowed.
4 SFD:(Size I_x, IN Bedrooms:,_#Bathe ,aBasement(w/wo bath): Garage- Deck: Crawl Space: 1/ Slab:_Slab:_
(Is the bonus room finished?(_)yes (_)no w/a closet?I )yes (_)no(N yes add in with#bedrooms)
U Mod.(Size_x )#Bedrooms_SI Baths_Basement(wtvo bath) Garage: Site Built Deck 'On Frame_Off Frame_
(Is the second floor finished?I )yes (_)no Any other site built additions?(i yes (_)no
❑ Manufactured Home: SW OW_TW(Size_s_)#Bedrooms:_Garage: (site built?_)Deck: (site bum?_)
• Duplex:(Size_x_)No.Buildings'. No.Bedrooms Per Unit.
• Home Occupation:#Rooms: II__F7�� 1 Use: Hours of Operation: #Employees:_
s.1 Addition/Accessory/Other.(Size SL�x�Vp)Use: Closets in addition?(_)yes (_)no
uo 3L�
tiler Supply: J County Existing Well _New Well(#of dwellings using well )*Must have operable water before final
-swage Supply- New Septic Tank(Complete Checklist) I.sting Septic Tank(Complete Checklist) County Sewer
• owner of this tract of land,own land that contains a manufactured home within five hundred feet(500')of tract listed above?(_)yes (_)no
I. the property contain any easements whether underground or ove,head(_)yes ( Vino
hectares existin! •r proposed):Single family dwellings: Manufactured Homes- Other(specify):
C.Lits11—P. n
equred Residential Property Line Setbacks: Comments:
ront Minimum Actual IO-( i,J IW_+ \O QJ F -( —
ear O ' • • .B •
_� ^^__�
•east Side
Mestrest/corner lot_
1 Building
same lot
Residential Land Use Application Page I 0l2 03/11
APPLICATION CONTINUES ON BACK
•
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: a L...... a G IeS ''e
art h j�scn Fnrm Pr]. R51-it on Sl ri1" JDhnSun- (Dec(ill on
II f permits are granted I a to conform all ordinances d laws of the Stale of North Carolina regulating such work and the specifications of plans submitted.
hereby state that rorepg ygl(fonts a accurate a red to the best of my knowledge. Permit subject I revor1bon if false Information is provided
Signature of or Owners Agent 0 te
'Mt 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 cf 2
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Application#
Harnett County Central Permitting
ton NC 27545
Each sedan below to be filled out 910 593 7525 POBox
9100 593 2793 www Monett org/parrnits whomever performing work rWpemnir
Must be owner or licensed
contractor
Address 00mpany Application for Residential Building'and Trades Permit
name 5 phone must match
Owners Name . • t . .!►!l 161!.4 I A. I I u / be I. . if.P. Dale
Site Address %exi 3cb Son R,td Phone.,�-, rl�. _3�
Directions to job site from Lillmgton Iii.r,� 4a I -toward ties Creek .
en-to }�rhnsn}�i)� run,l Rd. Ri3h+- Cft-117) Shari4 .ltiln )
Rd . frme 'r -4 on r; yht
Subdivision k ea fl is . ...a.. ' . IS Lot ___n_la___
Description of Proposed Work r-ES I(II'nin al k OYY1& #of Bedrooms 3
Heated SF P-it:p) Unheated SF 122 Finished Bonus Room') 110 Crawl Space t/ Slab
General Contractor Information
pBduiillding Contractor s Company Name Telephone
6pdress
-,,1 _ _/ Email Address
�it( .l J! VL1�
License#
Ellfdngal Contractor Informattoq /
Description of Work cf 51t i{101 Y F f i!. Sernce Size 4� Amps T-Pole /Yes_No
brw-isal E\CCtric (glq),;to1 - 2.g41
Electrical Contractors Company Name Telephone
l00 (Ann Rd, lupt�,y Baur NC 151),(0 Trvcdatostrp3mcu I. CanAddress ll Email Address
5 GI q$ - L
License#
•
J' echanicallHVA Contra-or Information
Description Wy1 Work i m C r IC11 i a 1 e I.
: c d _ , 9 • Q3 - O5
M -meal Contract. s omp • tame ephone
1,4 mi 'tell . -s Vc- 911 --1,
Addre . Email Address
License#
plumbing' Contractor Information
Description of Work f€5lt(ullinl rlu t) 1)Iai3 #Baths 3 t77
Jamie \iihn' in PIN n- mac (4101%14 -770
Plumbing Contractors Company Name j Telephone
lilt{ 4rti Rid hf.tnnIttie I aT5c3;13 `1(Jerk' Chil54)pllunhilija9AIirm>7
Address Bind Address J
License#
i • r • r .r.- r • w • r
Instila7S•ff•1T"' o pany Name&Address - _ . .
'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 planing beiow I have obt_m.d all au onireeiors
a nnunon to obtain that. wrmr and if may 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-5 Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is As ,-r • rrent :: schedule
'',/.. /LS i
• attire of ' :r/Contractor/Officer(s)of Corporation Dale
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 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 d 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= / /
Sign Writ APnI i it/. ,�-J
Date U>'re1 I�n
Plan Box# ( I t 9 Job Name I U.C'
App# 417 Valuatiod 64,14,nn SQ Feet
Garage /�07(
i
Inspections for SFD/SFA
Crawl_ Slab_ Mono_ Basement_
Footing Footing Plum Under Slab Footing
Foundation Foundation Ele. Under Slab Foundation
Address Address Address Waterproofing
Open Floor Slab Mono Slab Plum Under slab
Rough In Rough In Rough In Address
Insulation Insulation Insulation Slab
Final Final Final Open Floor
Rough In
Insulation
Final
Foundation Survey_ Envir. Health_ Other
Additions/Other
Footing
Foundation_
Slab_
Mono_
Open Floor_
Rough In
Insulation_
Final