DOCUMENTS Initial Application Date'. / i i({ / Application 4 I fl so o4I ySO
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street. Lillinglon, NC 27546 Phone.(910)893-7525 ext 2 Fax' (910)893993 www.harnettnerg/permits
^A RECORDED,�S�UUrRVEEEYY MAP.RECORDED DEED(OR OF ER TO PURCHASE)�/ Si SITE PLAN A E REQUIRED WHEN SUBMITTING A
LAND USE APPLICATION^
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City Otar it state/SSG zipaf✓r&ontaci No:iy se-/ 5f —nail 449M50/U//Va
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APPLICANT'1,(:e c t y/ (y.J attk/, 1-I-C Mailing Address.
GO(drress. FO Q / X1
City. OP a r) StateA)C. Zip:a'}J 6ontact No: Email.
`Please fill out applicant mbrmatior i1 aiiterent than
landowner /� rpc �/
CONTACT NAME APPLYING IN OFFICE: j i61icL S 4/ (3 Phone# �/�1 . 4 5 c9 S7
PROPERTY LOCATION:Subdivision: Irk ` �'� � : 3 3 Lot Size_x I-3
State Road# [(''(3� (-'�7 Stale Road Name.�hliettZ7%L Lal# p
Parcel. b-{ -!S n a �>p sa Map Book C.PageQUJ �l9�
��//���a.- to PIN: 9554— 81 — "?I� c�U c�
ZoninjtAa$ flood Zone. x Watershed IA 3aCt Deco Book B Page) &TipPower Company': ( lAt C
f
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PRO/POSED USE:
/�y SFD Siz c q//q_ k----Crawl
/ Monoluhic
( eGZ-x DO)t/Bedrooms/7i #BamsL r'8as ment(w/wo bath) Garage: ✓'Deck` :✓Gra Wl Space_✓Bleb: Slab
(Is the bonus room finished?(r 1 yes ( )no w/a closet?( )yes (ef o(if yes add in with#bedrooms)
❑ 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
❑ Manufactured Home: SW DW TW(Size x )#Bedrooms: Garage: (site built? )Deck. (site built? )
O Duplex (Size x )No. Buildings. No.Bedrooms Per Unit.
❑ Home Occupation #Rooms. Use: Hours of Operation #Employees.
U 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 before final
V'
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(500')of tract listed above?( )yes (Virio
Does the property contain any easements whether underground or overhead( )yes (✓)no
Structures(existing or .roposetl: .Ingle family dwellings Ma ufactured Homes: Other(specify).
Y s
Required Residential Property Line Setbacks: Comments:
r
Front Minimum 35 Actual
Rear 25' 4.0.±2(
Closest Side 15 r ' i t1 t
SidestreeVcorner lot
Nearest Building
on same lot -
., Emir ' o(2
APPLICATION CONTINUES ON BACK
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SPECIFIC DIRECTIONS 0 THE PROPERTY FROM L NCTTON: W ..//a"�J 0 .JT!� 0,4_- J4 �
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o � r%vS�C Gt . �2 �O ' n'`er-- lso"/iL ,9% 7c,
If permits are granted I agr form to all ordinan and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that for mg state is are accurate nd correct to the best of my knowledge. Permit sublet tore cation if false information is provided.
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Signator caner or 0 is Agent Da
—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-
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N 22' 13 71.o(i 115'1[ 1S/iti"
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CCLMMBERLLAND HOMEES, GNC. e
LO * 33 CCAROUNA SEASONS ci
THE LANDON Wo if n SCCIRE =N PORCII1
SCALE: 1":4O '
3314
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SIRE PLAN APPROVAL
OISTRICI \'n; _c E
1SEDROOMS
fI seta
n, traior
,T. 4•� � wa � -�
S 26` Q 46.0000" E 44'-4 5/16" 4=335'-0"
AL=35'-8 1/4"
SPRING FLOWERS DRIVE
NAME:j �'/ot rite_ •
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,CHANGER 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#
r Environmental Health New Septic SystemCode 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 atfor 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 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 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 & 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 he ranked in order of preference, must choose one.
1_1 Accepted 1I Innovative 1 ✓I t;onventional
LI Any
I Alternative 1-1 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 _l
NO Does the site contain any Jurisdictional Wetlands?
I YES I_ItilY'O Do you plan to have an irrigation system now or in the future?
1_IYES 11.--(810 Does or will the building contain anyins!Please explain. _
IYES j—NO Are there any existing wells, springs, waterlines or Wastewater Systems on this property?
IYES 1 LFCM Is any wastewater going to be generated on the site other than domestic sewage?
1I YES 1l�N'O Is the site subject to approval by any other Public Agency?
1IYES ILYNO Are there any Easements or Right of Ways on this properly?
1—)YES 1 I-11810 Does the site contain any existing water,cable,phone or underground electric lines?
If yes please call No Cuts at 800-632-494910 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 End.. That I Am Solely Responsible For The Proper Identification And Labeling Of All Properly Lines And Corners And Making
• e Site Ac•ssible So I A Co • - e-ite Evaluation Can Be Performed.
PROPERTY O v 'MR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) BATE
10/10
NORTH CAROLINA -s-vs COUNTY
CONTRACT TO PURCHASE
This contract made anc(entered igto this k 4 " day of s-✓--‘yy 20 Vi by and between
('re tam OeAJ �.s. as SELLER,and Cba .ntt4a,d l�ow,:3 as BUYER.
WITNESSETH
THAT SELLER hereby contracts to sell and convey to BUYER,and BUYER hereby contracts to purchase from
SELLER,the following described residential building lot/s,to wit: `
Being all of LOT/S IS of Subdivision known as CPt>;��4 aecisov.-.5
A map of which is duly recorded in Book of Plats Map g0O9 Page OO`i f a County Registry.
Price is ff OLYJ"Cd payable as follows:
Due Diligence made payable and delivered to Seller $
Initial Earnest Money deposit(To be held by Lynn Matthews Law Group) $
Balance due at closing $
1. The LOT/S shall be conveyed by SELLER to buyer by a General Warranty Deed free of all encumbrances
other than taxes for the current year;which shall be prorated as of closing.The Deed shall be subject to
all Restrictive Covenants, Utility Easements and applicable zoning ordinances on record at the time of
closing.
2. Buyer acknowledges inspecting the property and that no representations or inducements have
been made by the SELLER, other than those set forth herein,and that the Contract contains the entire
agreement between the parties.
3. Closing (Final Settle ent) is to take place no later than t 'cloy) at the offices of
fyAQ144v,..sya..> Should BUYER fail to close, the SEL R, at his option, may retain sum
paid as a Down Payment upo the Purchase Price as Liquidated damages and declare this Contract null
and void and may proceed to resell the LOT/S to a subsequent Buyer.
3. (a) Cumberland Homes has agreed to pay all of the sellers closing costs in regards to the settlement
of this property.
4. Due Diligence: Made payable and delivered to Seller by the Effective Date of the contract. Due Diligence
period beginning on the effective date and extending through 500pm on . Time being
of the essence with regard to sold date.
IN WITNESS WHEREOF the parties have executed this contract this day \Z ^ of ��� ,
__COrt
SELLER BUYER �41Lla 4040-$Ek •
09/09/11
Application#
Harnett County Central Permitting
Each section below to roe tilled out PO Box 65 Liilmgton NC 27546
by whomever performing work 910 893 7525 Fax 910 893 2793 www ha-nenorg/pennirs
Must be owner or licensed
Contractor Address company Application for Residential Building and Trades Permit
name B phone must match ,,
Owner s Name �_✓[` 71004 tits _ Date 7/1A
Site Andress (/ " i- - / r, Phone 'C/- d-P - KS--
Directions to lob site frpm Lllhng(on ay 7 O S ' ( _,./ ;se:" .y,.)
Subdivision (1,—JyOk.e_ 4l .re Lot 53 L
Description of Proposed Work /Y/5 r #of Bedrooms ,7
Heated SRZ,,C f' Unheated SF(1Z4 Finished Bonus Room, h Crawl Space k Slab
General Contractor Informatio �/
.41 I < .1A go A . G • /a- �'9z - 7 3fz5--
B tiding CotOractors Compaar,Name Telephone
o '7R7 UaM.r Al C. „7 335 avrr,'Sb lo(t'r. . r
Address61 q 3 Email Address yah a0. n
License # '
Elec.,: ,ca o tractor Information
Description of Work /t/ Kto S/ Service Size,-2(0 Amps T-Pole L.-4es No
ilig-Sfer + are 1< rie__ 4/.9- $94- 53$9
Electrical Contractor Company Name Telepho e
5414. L-d? %Jct �, -116r. 4/ A
Address r
Email Address
12097- G(
License #
Mechanical/HVAC ContiInformation
Description o/f�W ork �•_ a.4/ t. � 6..
!/_ 7/-i -r`_i e N�j s- I rrr CCC q/4- 5;)7rp -/J�
Mechanical Contractors Comp-ny Nam- Telephone
-P.c. / /7 _• , a
A .c il
Address Email A dress
, li/ Z-
License #
Plumb, • Co actor Information
Desch bon of Work AGI !$f in ' #Baths
Gwe� �� r. / 1� / Z�/' 4/1q— 57-ci9�gt
Plumbing Contractors om.an Name G Telephone
i 014: _ - A( '24.
f// . - /✓A
Address a753L Email Address
a3i�o
License #
_ _ Insulation Contr. tor Information
ir '
Insulation Contracts s Company Name & Addres Ranee
OffTelephone
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'NOTE General Contractor must fill out and sign the second page of this application
I hereby certrfy 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 stoning below I have obtained all subcontractors
permission to obtain these permits and if any 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
EXPI ERMtT FEES - 6 Months to 2 years permit re-Issue fee is $150 00 After 2 years re-issue fee
I s per current fee schedult
��,� �j64//I
Signature of Ot1 ontractor/ er(s) -el-Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The undersigned applicant being the
--
General
General Contractor Owner 1----- 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
sett forth in the permit
✓ as t)Hhree (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
V 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 prior
to issuance of the permit and at any time during the permitted work from any person firm or corporation
carrying out the work d
Company or Na - /1/711).47-1—If/t-,,:-14/W‘ kj/t C -
li Sgnw1Titt. _ ii f( .r� 1 ��� Date i