DOCUMENTS Initial Application Dale: ` /pi-girl Application# "LO
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,LiIlington,NC 27546 Phone:(910)B93-7525 ext2 Fax:(919)893.2793 www.harnett.org/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER:Wynn Construction, Inc. Mailing Address:2550 Capitol Dr.Ste 105
City: Creedmoor Siete:NC zip:27522 Contact No 919 603-7965 Email: edward@wynnconstruct.com
APPLICANT':Edward Averett Mailing Address:2550 Capitol Dr.Ste 105
City: Creedmoor Stale:NC Zip:27522 Contact No: 919 603-7965 Email: edward@wynnconsiruct.com
'Please nil out applicant information IIdifferent than landowner
CONTACT NAME APPLYING IN OFFICE:J. Edward Avefetf phone#919 603-7965
PROPERTY LOCATIONSSubdivision: Avery Pond 1 Lot#: , f� -Lot Size: rfi
Slate Road et 213 Slate Road Name:_ ii_ue Poch- +tea1.`r Ma Book&Page: 20/4 l �
Parcel: p OSOfc3 002? V PIN: 0(05-3- 36 - -000
Zoning: RR3o Flood Zone: $ Watershed/QC) Deed Book&Pager ,J
/O 70 1 Power Company: Duke Energy
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
' /^� / Got / Monnudd.
0 SED:(Size (0 x(00)#Bedrooms; #Balhs:�' Basement(' 'qw bath): Garage: ✓ Beek:✓ Crawl Space: Slab:_Slab V
ps the bonus room finished?(✓oyes _,no w/a closet?( )yes ( )no(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 DWTW(Sizex )#Bedrooms: Garage: (site built?_)Deck: (site built?_)
❑ Duplex:(Size x )No. Buildings: No.Bedrooms Per Unit:
•
❑ Home Occupation:fi Roams: Use: Hours of Operation: //Employees:
❑ 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
Sewage Supply: V New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) County Sewer
Does owner of this tract of land,own and that contains a manufactured home within five hundred feet(500')of tract listed above?( )yes ( )no
Does the property contain any easements whether underground or overhead( )yes ( 1 no
Structures(existingsC mposed): 'ogle family dwellings: Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum 35 Actual-J7_
Rear 25 /eS
Closest side 10 1°'Z'
Sidestreet/carner lot 20
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: From HCCP right onto 210 Hwy.3 miles, Left on 401 Hwy.for 15 miles
Left on Chalybeate Rd.for 1/8 mile,Avery Pond on the left
If permits are granted I agree Dolor to ordlnanc nd laws of the SI a odh Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoi e . Tema a accurate rre to the ba knowledge. Permit subl c-to rev talion If false information Is provided.
tura of Owner wner'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 dale If permits have not been Issued"
Residential Land Use Application Page 2 of 2 03/11
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NAME:_ IM _.U✓tne aO.ill/t'C- - APPLICATION N:
/ *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 l 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 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 nate
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.
0 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 be ranked in order ofpreference,must choose one.
{_} Accepted {_) Innovative feonventional {_} Any
{_) 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 the answeranis"yes",applicant MUST ATTACH SUPPORTING DOCUMENTATION:
(�}
{ }YES `NO Does the site contain ally Jurisdictional Wetlands?
{ }YES {!J NO Do you plan to have an irigatifazglem now or in the future?
{ }YES (dr< Does or will the building contain any drains?Please explain.
(_)YES (/)N Are there any existing wells,springs, waterlines or Wastewater Systems on this property?
(_)YES {NOIs any wastewater going to be generated on the site other than domestic sewage?
{_)YES {,1140 Is the site subject to approval by any other Public Agency?
{_}YES {/} NO Are there any Easements or Right of Ways on this propeWy?
{ }YES {zO 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 flee 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 Underst h I m Solely Resp Bible For The P• tifiention And Lnbeling Of All Property Lines And Corners And Malting
The a essi So at Co ere ' vnluati •ormed.
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RTY ERS OR OW i S LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
DO NOl REMOVE'
Details: Appointment of Lien Agent rneo oenl(,on
rWW1. It In! III
Initially uwn by wynnlionioc
DeslgllBlecl I.Ien Ayer! Project Property Print 5 Post
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Harnett County Central Permitting + 7`5 00 // /03
PO Box 66 U@nelon NC 27646
Each below to be Pled out 6169637626 Fax 9106932783 www lamamg/permits
whomever
by whanwer pedormnp work
Must teoymar or licensed
contractor Address company Application for Residential Building and Trades Permit
name 6 phone must melon ''..11 �s q
Owners Name k)4 totsi iekin l jilt. Date 7-Y7
Site Address_ nvel1.0Ideid De; Phone 9/960;-]963
Directions to job site from Ldlington Rem HeCP r;y kf a Uo Ski 3a4r Ie Leff and 4/e/04
for IT rtrc Le-44 eel C.halybea}r Ed kof YR wle I 13rler7 Pe&aid leff.
Subdivision 793 4/Cry laud Lot 3 8
Description of Proposed Work Neu) Cnr/s trans 's✓ - Sf0 #of Bedrooms
Heated SF So?? :unheated SF 5.5,3 Finished Bonus Roomv- Kr Crawl Space , _Slab ter
General Contractor Information
614ty% LnAslfue-t:eM Pio. 919 603 . 7965
Building Contractors Company Notre Telephone
zsso ('a N+ol R'. Ste /as&ea4rrit 27s22 erliddrI@w�M%eses.ea2
Address Email Address
yGa9s
License#
./_ �(@�t(Loal Contractor Information
Description of Work /1/eu1 emsfrgc+r0AI Service Size jo0 Amps T-Pole _Yes_No
Q. R, 5aeksoM Clem/,-r`L 9/7 730- /Zs/
Electrical Contractors Company Name Telephone
92-6% 2ale;gk1d. 13alsodt1 Ne- 2-7157)V
Email Address
zliY I
License#
echanicail JJ�iVAC Contractor Information
• Description of Work /(lead Constrife nr✓
(Ier+:C:ed- Neat gild A:r 9/0 8S8-tooO
Mechanical Contractors Company Name Telephone
7?l bSaaset<akeAi. ehmth;r3rdye./tflis7
Address Email Address
NtwAoll2 113 elau1
License#
plumlyng Contractor Information
Description of Work i01.1
eptcfrarthie d #Baths- �' 5-
1rutrs /lt hip 9/9.5—co- 4133
Plumbing Contractors Companyilarhe Telephone
3/6o-/+ OAorN. ('lay/nr Alt Z73-2.?
Address Email Address
2,245-2--
License#
Insulation Contractor Information
7Tht, .Tsa/ztf°R/ 9/9106(-0999
Insulation Contractors Company Name S 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 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 sinning below I have obtained all subcontractors
permission to obtain these permits and if gny 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
EXPIRE PERMIT FEESssssEEEEEEhh -13 Mon s to 2 years permi a-issue fee is$150 00 After 2 years re-issue fee
is as p curreadule �G� .//
i lure o 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 _Owner f 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
r/ Hes three(3)or mare 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
Hes 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 worker s 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 ,'/ /1 �[�
Company or Nam A1Ml CA/6/�7f4t=�rOd✓1 J,t(t. // ®
Sign wlTitle U•GG &ga. Gd040 Date 7 -/7