DOCUMENTS Initial Application Date: I ( .. Ir I Application# in 5(43.M4 q V J
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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.harnetl.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 Stale:NC Zip:27522 Contact No'. 919 603-7965 Email: edward@wynnconstruct.com
APPLICANT':Edward Averett Mailing Address:2550 Capitol Dr.Ste 105
City: Creedmoor State:NC Zip.27522 Contact No: 919 603-7965 Email: edward@wynnconstructcom
'Please All out applicant Information if different than landowner
CONTACT NAME APPLYING IN OFFICE:J.Edward Averett Phone#919 603-7965-76
PROPERTY LOCATION:Subdivision: Avery Pond �u er� Lot#:-76 -Lot Size: '
Stale Road# 3 / IF State Road Name:
p_ 1 POI.)O'--lbr• pr Map Book&Page: 4 /Zo✓
Parcel: OSD( S3 4002 / p6Z 1 PIN: OW -Z'b Ri 9-000
Zoning: RR3o Flood Zone: ) . Watershed. I\ Deed Book 8 Fag:3 IO 1 704
Power Company': Duke Energy
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
�J e'er. / Monnlrry
SFO:(Size lOV x�O)#Bedrooms:? #Baths:2. Basementeryw bath):_Garage: ✓ Beak:✓ Crawl Space:_ .Slab:_Slabs/
(Is the bonus room finished?( T'yes _,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 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?( 1 yes ( )no
Water Supply: 1 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(50D)of tract listed above?(_)yes ( )no
Does the properly contain any easements whether underground or overhead( )yes Li no
Structures(existing or ogle family dwellings: / Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
p ,
Front Minimum 35 Actual 3 —_/
Rear 25 13).22
10 ) 3 7
Closest Side
SidestreeUcorner 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/B mile,Avery Pond on the left
R permits are granted I agree • onfor to ordinan nd laws of the St a odh Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoi . eme a accurate orre to the be 1 knowledge. Permit subject to rev cation If false Information Is provided.
diftare 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 date If permits have not been issued"
Residential Land Use Application Page 2 of 2 03/11
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SITE PLAN APPROVAL.
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NAME: / t 4tdnie 4 Zit - APPLICATION II:
*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 M 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)
9I0-893-7525 option 1 CONFIRMATION k
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.
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 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 { ) 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 answer is"yes",applicant MUST ATTACH SUPPORTING DOCUMENTATION:
{_}YES {,/�'an(NO Does the site contain any Jurisdictional Wetlands?
{_}YES VINO Do you plan to have an in'iaatinn system now or hi the future?
{ }YES (jj tv9 Does or will the building contain any dfgjps? Please explain. _
(_)YES I ))N Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
(_)YES (NO Is any wastewater going to be generated on the site other than domestic sewage?
{_}YES (/(NO 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 (..."(N.0 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 Underst I h. I m Solely Resp sible For The P' tification And Labeling Of All Properly Lines And Corners And Making
The a ass' So at ACo ate ' valunti 'armed.
'/�t -/7
• • • - RTY ERS OR OW i S LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
DO NO REMOVE II
Details: Appointment of Lien Agent rmn on .t,alzo -i
n.tiy lie ^on Iri nen,/ II Pr] by wvnn pupe_r
❑esignsturl llen Agent Prcjeet Property Print & Post
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Owner Int Information
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Harnett County Central Permitting f-
Each section below to be filled outPO Box 85 LAhngion NC 27546
by whomever performing work 910 893 7626 Fax 910 803 2793 www hernett org/permits
Must be owner or licensed
contractor Address company Aaahcation for Residential Building and Trades Permit
name 8 phone must match ''.. `` ,3
Owners Name WIT L.OdStr'tu-��aN rex. Date 9 -17
Site Address 378 //'dery Pose/ hr. Phone n603-2745--
Directions
/9603-j9LSDirections to job site from Lillington Ram /IGLP r;11,10 z.io fi 3ar Its LeE4 alit ya//fd,
for ICm'Ir� LeilON C NAIbake P-d kat. YRla.le , Hoer', pcwdn,if /eft. 7
Subdivision �Autry BudLot
Description of Proposed Work /l/GfJ L.�i OaS litxC74A/ - 5f0 #of Bedrooms
Heated SF 21810 Unheated SF 77Z- Finished Bonus Room'' /4 Crawl Space Slab f
General Contractor Information
k)qv G7g5,4 et:efi nett, 919 603 . 7965
Building Contractors Company Nalre Telephone
Zero e N401 C4-. Ste /os&e einwrdk 27s22 edwarina 4//nitlfcnes.eaot
Address Email Address /
516295---
License
t629SLicense it
Blectrical Contractor Information
Description of Work Nett) Carslrae ,oA/ Service Size 3c0 Amps T-Pole ✓ Yes No
Q. H. Sacksou eet-Ir:t 9/9' 73o- /Zs/ - —
Electrical Contractors Company Name Telephone
9261 2M&4k�d. 130tsoa, 22,57W
Address Email Address
2/1 V/
License#
echanicaI%THjVAC Contractor Information
Description of Work
Nie atsfrael0A/
(er+:G:ed- Neat a4Jd. A:r 9/0 esB-060o
Mechanical Contractor s Company( � Name Telephone
79 f. tAakeht Jrfaaa-Ndre-Nt a tic'?
Address Email Address
iVe.2002/2 113 c%ssl
License#
A.a/,'�,�' n P/lum Cot to
Description of Work 7 Cfa 7/ii /o,✓ #Baths .2. .5
lra �s /an.o/29 9/9.s-co- 9133
Plumbing Contractors Company NaIifiie Telephone
3/6o-4 (lurk]. (!/ayiba Alt 274-2'7Address Email Address
Z1/5-2.-
License#
Insulation Contractor Information
Tf�,ct _Thsa/Pt bd/ W9 40-0999
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 slnninn 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 -6 Mon s to 2 years perms a-issue fee is $150 00 After 2 years re-issue fee
is asp Curren a edule
8 - ► 7
i tura of 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 V.-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
!/ Htae 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 hes 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 //!!
Company or Nam' RIM £iA? ft ei lie �/ g
Sign writhe � ! /L/� L.d T L6FHG` Date -/7