DOCUMENTS Initial Application Date: L Ia1 / / Application I' ISC'
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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:(91D)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 State: Zip:Zip:27522 Contact No: 919603-7965 Email: edward@wynnconstructcom
APPLICANT':Edward Averett Mailing Address:2550 Capitol Dr. Ste 105
City: Creedmoor Slate:NC Zip:27522 Contact No: 919 603-7965 Email: edward@wynnconstruct.com
'Please fib out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: Edward Averell Phone#919 603-7965
PROPERTY LOCATI
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NSubdivision: Avery Pond 1 Lot#:J7=Lot Size: _
Slate Road# 11 State Road Name:_ z14OerLI D 1OAs6 {�Lr' Map Book B Page: ZZG /24/Parcel: 2190 Flood
002? 93 'PIN: 0(05* % V7Y1-000
Zoning: 2P30 Flood Zone: /' Walershedit Deed Book&Page:351 c)/ I(APower Company": Duke Energy
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
/ �/ CY / Manu
(Q SED:(Size (d//^�x 190)#Bedrooms:7 #Baths:2 Basementb-So bath):_Garage: ✓ Desk:✓ Crawl Space:_Slab:_SIabV
Ile the bonus room finished?(_ yes _,no w/a closet?( 1 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?( 1 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 Occupation: 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: ✓ 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 ( )no
Does the properly contain any easements whether underground or overhead(_J yes ( )no
Structures(existing o I oposed): ingle family dwellings: I Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks; Comments:
j
Front Minimum 35 Actual_Jbrn
Rear 25
10 1/ 7
Closest Side
Sldestree&corner lot 20
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
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 Chalyheate Rd.for 1/e mile,Avery Pond on the left
If permits are granted I agree • =for to ordinan nd laws of the St a odh Carolina regulating such work and the specifications of plans submitted.
I hereby state that forego' : . eme accurate erre to the be knowledge. Permit subject to r cation If false Information is provided.
dirlure of Owner wner's Agent Dale
"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"
Residential Land Use Application Page 2 of 2 03111
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XIV/NAME: {M KS//{ XIV/�nf� APPLICATION if:
/ *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 1 CONFIRMATION#
Environmental Health New Septic System Code 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 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 Ild 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 of preference,must choose one.
{_) Accepted { 1 Innovative (Conventional {_) 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 {ENO Does the site contain any Jurisdictional Wetlands?
{_)YES {i✓}NO Do you plan to have an'' f .y,A,M now or in the future?
{_}YES {Ary Does or will the building contain any dl'&im?Please explain.
(_)YES (( Are there any existing wells,springs, waterlines or Wastewater Systems on this property?
{_)YES f /NO Is any wastewater going to be generated on the site other than domestic sewage?
{_}YES {i)ANO Is the site subject to approval by any other Public Agency?
{_}YES {/}/NO Are there any Easements or Right of Ways on this property?
( )YES (...(1(10 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 Hove 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 Undersh a h, I m Solely Resp sible For The P ;' - tifirntion And Labeling Of All Property Lines And Corners And Making
The e ass So' at A Co ate,valuati•ly d, •• ' armed. 7 '--17//7
RTY ERS OR OW • 'S LEGAL REPRESENTATIVE SIGNATURE REQUIRED)islDATE-`
10/10
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Harnett County Central Permitting /2,5-oO y/9Qy
Each section below to be filled out PO Box 65 Lamgton NC 27648
910 893 7626 Fax 910 893 2703 www harnell oro/permne
by whomever performing work
Must be owner or licensed
convector Address company Application for Residential Buntline and Trades Permit
name 8 phone must match C q '7
Owners Name (ALw aid-rad cP4 r rNC. Date 7 �{
Site Address •_ A 110/lid De Phone 9/9603-J96S"
Directions to job site from Lillington 1n . NGLPKat ktaz.IOffwrg 3,4;les Leff oN40/NA11
for ISrZlPc 1..e.4 Dig &alilbea4t Rd key. %Rwls , Ader7Po✓d.ng /e(#.
Subdivision 249 Autry &AS 1- r. Lot 3 q
Description of Proposed Work Alt& e�r get frue4s s/ — 5M #of Bedrooms 3
p
Heated SF="W:Unheated SF it* Finished Bonus Room'? `1 Crawl Space , Slab ✓r
General Contractor Information
big INA etrAc-IrUA.+;edte. WY /003 . 776 5-
BuildiAg Contractor a Company Nellie Telephone
2-sro (la N4o1 1:4-r Ste '°c&eceiaerife 27122 edtddrie440q/ior+es.C.t
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Address Email Address /
An a9S
License#
�ElIeeaatt�ical Contractor Information
Description of Work Nei eogs/rUet1ON Service Size 700 Amps T-Pole _Yes_No
t. A. Tacksoai 6s4,-:t 9/9 730- /Lr/
Electrical Contractor s Company Name Telephone
9261 Pale,gkd. Sousa,Ne- 27,5-09
Address Email Address
211 yN
License#
JlechanicaUtIVAC Contractor Informabor
• Description of Work Weal ttstrae rbs
ter+:t.ed. Neat a.AtcL A:r 9/0 fig-Oboe
Mechanical Contractors Company Name Telephone
727500et4arkek. 2aaberdpe-MC 1$367
Address Email Address
/k200212 113 66451
License#
Contractor Information
Description of Work eihd #Baths Z' _
1rdiarrrs % i9 9/4sco- 9733
Plumbing Contractor s Companysidle Telephone
3/60-A- Otorkl. C/ayfna Ne_ 27021
Address EmailAddress
2,2-/rid
License# •
Insulation Contractor Information
7Th' Tsa/zt'4/ 9/? blot-D999
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 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 ammo below I have obtained all subcontractors
permission to obtain these permits and 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 Permitting Department of
any and all changes
EXPIRED PERMIT FEES-S Mon s to 2 years permi e-issue fee is$160 00 After 2 years re-issue fee
is as p curie hedule — 7
71
/�i tura o Owner/Contractor/Officer(s)of Corporation Date '
G Affidavit for Worker's Compensation N C G S 87-14
The undersigned applicant being the
General Contractor _Owner V.-Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the pereon(s) firm(s)or corporation(s)performing the work
set forth in the permit
t/ 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
1/ 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 /A!
Company or Nam, �AA (IORS�F'!! r 01d -lite,
Sign w/Tdle 0 Date 7 -/7