DOCUMENTS Initial Application Date."-1 in 1 Application f SCC) 4- I ICS
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.harnettorg/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN
'SUBMITTING A LAND USE APPLICATION'
LANDOWNER.(504.4/11/1 T"kI Heel Pf LLL Mailing Addres &X a J5
City: An)ler State/ ':
Zip3-7511i Contact No: 919-tw335/l Email:
APPLICANT•: --cjV//lG/NVn /OVA KMts�LygZ Mailing
Address:(0n enx)-I?C
city: An9C✓ tate: /"_` Zip a?say Contact N q(q- 63C_yJ7) Email:
*Please fill 601 applicant information if different than landowneran / / (� /�
CONTACT NAME APPLYING IN OFFICE: Klrre�,/7y.1_Z?fnK�Q."1/' Phone# 7 /4-5;27-
PROPERTY
/
PROPERTY LOCATION:Subdivision: TYV1(J I R'f t,�A- . ckee✓ p �( Lot#': S Lot Size: /Qc✓t't'
State Road State� Statt�e�Road
''NNa�mje': �QL •v.+�a� r ,ZGq Map'Book
�8 P�ag(re1(DI 1S"
3
Parcel:
77/+� C OLQ( W D3 PIN: ( i. J LDI - Ia - 4IoIDl0 a CW
Zonin?,A Flood Zone: f� Watershed: Deed Book 8 Page:2 T �f41 (cO Power Company:
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROP USE:
Y .N MonolithicSFD.(Size77 x13 )#Bedrooms:.3 #Baths:�.Basement(w/wo bath)'.Jzdarage: I/ Deck:(/ Crawl Spac _Slab'.V Slab'.
(Is the bonus room finished?(_)yes (_)no wla closet?(_)yes (_)no(it yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms It 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.
U Home Occupation:#Rooms: Use: Hours of Operation: #Employees.
❑ Addition/Accessory/Other:(Sizex )Use: Closets in addition?( )yes ( )no
Water Supply. -/ County Existing Well New Well(#of dwellings using well )'Must have operable water before final
Sewage Supply. t.N we 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 ( moo
Does the property contain any easements whether underground or overhead(_)yes (_ no
Structures(existing o •ropos-• ingle family dwellings: t- Manufactured Homes'. Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum 3S Actual I d4
Rear as �V J
Closest Side I r?"-•I
NieastrteVclingr lot
Nearest Building
• samelot
lot
Residential Land Use Application Page 1 oft 03/11
APPLICATION CONTINUES ON BACK
•
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: rein ?V- lT 0' P70 '/ h 111, ) Qom._
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 sents are a ra and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
717-i 7
r
gnat of ner or Owner's Agent Date
"'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 issuer
Residential Land Use Application Page 2 of 2 03111
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SITE PLANK APPPPRROVAL !�
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DISTRICTS+=�-3SE` r7.1-
XB^BDRUUIJ,S 11
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��'' Date.. y :1,
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NAME: ln1Jsikkaarn T�_kTh APPLICATION#:
*This application to he 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)
)0910-893-7525 option I CONFIRMATION#
' 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 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 verity 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 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 desiredresystem types 1: can be ranked in order of preference,must choose one.
{ 1 Accepted { I Innovative ( t/I Conventional ( i Any
1_) Alternative t_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 { '1' O Do you plan to have an irrigation vvstem now or in the future?
I }YES { O. Does or will the building contain any drains?Please explain.
IIVES I NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property'!
(_IYES (_�(NO Is any wastewater going to be generated on the site other than domestic sewage?
IYES 1 LI/NO Is the site subject to approval by any other Public Agency?
(_IYES 1 t<NO Arc there any Easements or Right of Ways on this property?
(_IYES ( Lj 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 C plete Site Evaluation Can Be Performed.
� 7-/7 0
PROPERTIOid S OR WNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DAM
la/10
09/09/11 Application#
Harnett County Central Permitting
Each section Nbwb be heed outPO Box 65 U*Von NC 27546
by whomever performing work 910 893 7525 Fax 970 993 2783 www/lemonorarpermM
Must be caner or licensed
contractor Address company Application for Residential Buildina and Trades Permit
nems a phone must match
Owners Name SJAP/n Too(A /roan Date 7-1717
Site Address /11a17 /xis Phone9/9-/34-qi?--
Directions to fob site from Lillington !O-Ace oc "41/,4-+5- Pel ,/- a/c my
Subdivision Lot
Description of Proposed Work #of Bedrooms 3
Heated SF Unheated SF Finished Bonus Room?_Crawl Space _Slab
General Contractor Information
£)Mevn lourhi &inter e,Ge 914-‘7 -`/(7c?--
Building Contractors Company Name Telephone
71- se- ,-l3S .4)/ 27so I
Address Email Address
78a7o
License#
Electrical Contractor Information
Description of Work Service Size ;a, Amps T-Pole �es_No
-51/UO t/rck(ic 9/51 -u77- ess�
Electrical Contractors Company Name Telephone
/94 SSS /1-1c M r) ting ; /t 7fr, (
Address - Email Address
?o7-L
License#
Mechanical/HVAC Contractor Information
Description of Work
Cq(o/vd Conic'/ /IKIs-2> 3-5-n - 77//
Mechanical Contractors Company Name Telephone
Ca- ' - us- As 7o Lae;f r lay /NI A/-c,
Address Email Address
D- 9077
License#
plumbma Contractor Information
Description of Work #Baths
Dovd1P ;P4,n,hn5 L( ✓ 9/o -6-pi— 7 70,.S`
Plumbing Contractor s Comm3�any Name// Telephone
(y �y glycd /It1 (inn-at-UPI ALC.
Address Email Address
-a/ 6 '/ 9
License
Insulation Contractor Information
Ir G'rlV Shu-3ok- 713g
Insulation Con�N/actor s Company Name it Address Telephone
*NOTE General Contractor must fill out and sign the second page of this application
I hereby certify that 1 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 pv swanpna below I have obtained all subcontractors
permission to obtain these permits and if ppy changes occur including listed contractors site plan
number of bedrooms budding 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-S Months to 2 years permit re-issue fee is$150 00 Atter 2 years re-issue fee
is as par current fee s ule
7- i7 - / 7
ria of r/Contrector/Offoer(s)of Corporation Date
Affidavit for Worker's Compensation NC 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
White working on the project for which this permit is sought it is understood that the Central Perming
Department issuing the permit may require certificates of coverage of workers compensation insurance pnor
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 Name
:�/.SOUM ✓/7 /00 L/i Hones' LIC
Sign w/Title ��G' P Vert Date 7-r7-/2
DO NOT REMOVE!
Details: Appointment of Lien Agent
Entry M: 600200 Flied on: 0e/03/]01]
Initially filed by:
a0 uthe rntouchhomeal I c
DesIgn.ted Llen Agent Project Property
Print & Poet
Investors Title Insurance Company Lot 3
1252 Matthews Rd �•: v�
ueibe m6mu:e.eom Lillinapen,NC 27546 A 1N
Address;19w.Hargett S...Suite 5m;Raleigh,NC Hamm County
27691 0 l:r^
Phase:nen9043g4 Property Type Contractors;
Emw:al�p®Yenmr mm-.. .. Please past this notice on the lob Site.
1.1 Family Dwelling Suppliers and Subenopnton:
Sea:this image with your smart phone
mew this filing.You can then rile a Naha
Owner Information Lim Agent for waprojeat.
Southern Touch Homes LLC
PO Box 2135
Angier, NC 27501
United Sures
Email:wutem uchhomeslle@gmail.eom
Phone:919-6394672
View Comments 10)
Terhnital Support Hotline:(888)6961384