DOCUMENTS Initial Application Date: (l Jit /S Application# ''1 �F� ����/ Yp�fSI
CU# CALVS ort.1 �
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.hamett.orglpermits
"A RECORDED SURVEY
�MAP,
�RREECOR�DDEEDDEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND1USE APPLICATION
n_,
LANDOWNER:, 1 ' I • 4 11 � .CC11''//'' Mailing Address:0Z( 3(0 5 pt-i vQI 17 rI ) L.a T/) �/
City: t t1lr��ssn Stater C,Zip:K ,51kentact No. Email: o
APPLICANT*:1?YCXul P\9e I C a(QV ZLI Mailing
'Address: S S f I lieL e Poi
City': (none it h d State. 11./C. _2i�[Zip: Contact No: Email:
'Please fill out applicant information if different than landowner //�� ] p
CONTACT NAME APPLYING IN OFFICE: /1 ��y I Phone# -1 /0 709 990 / A
PROPERTY LOCATION:Subdivision: ITV l � Lot#: L Lot Size: I• C0 `,
State Roa�d�#['' €�4 (State Road Name'. JK. LOO.."-AL. .�f MapapBook&Pagge.\99 114S6
Parcel: (�/V/�-�ss�� C? i J b/1 Q //�1 PIN: PSI, S- D / - (piste `WO
Zoningj�JYAf7. Nood Zone: )C Watershed�4 Deed Book&Page. �nower Company: r^
'New structures with Progress Energy as service provider need to supply premise number ^^ __-•,� from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Size x )#Bedrooms._#Baths'. Basement(wlwo bath)._Garage:_Deck._Crawl Space:_Slab: Slab.
(Is the bonus room finished?()yes ( )no wl 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 ON Frame
(Is the second floor finished?( )yes (_)no Any other site built additions?(_)yes (_)no
U Manufactured Home._SW_DW_TW(Size x )#Bedrooms._Garage: (site built?_)Deck:_(site built?_)
U Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit.
O Home Occupation: Rooms: Use: Hours of Operation: #Employees:_
tCo X 1 L I/ra),� � �_r��4_�_�fir� -p e
Addition/Accessory/Other':(Size /lax{(0 )UseC, f.reCA fD'#7.--'T 1 ITC�'1. Closets in addition?(_)yes
Water Supply: Gory Existing Well New Well(#of dwellings using well )`Must have operable water before final
Sewage Supply: New Septic Tank(Complete Checklist) tsting Septic Tank(Complete Checklist) County Sewer
Does owner of this tract of land,own land that contains a manufactured home within five hundred feet(5001 of tract listed above?( )yes ( )noo /
Does the property contain any easements whether underground or overhead(_)yes (_)no � YQ
Structures(existing or proposed):Single family dwellings: Manufactured Homes: 1 e Other(specify): l'-1:1 $A
y�
i
Required Residential Property Line Setbacks: Comments: W\
�C 1 a.dtdtfr.-
Front Minimum -SS Actual�lac) f�staA.�1( ee l
Rear » /Cl (� _(y 1 �-1 '\ , n/'� '\
Closest Side U u (99 g.Q„-'j >.{ { / 6 OV L 9 O Loco
Sidestreet'corner lot e3. ..
Nearest Building
on same lot
Residential Land Use Application Page 1 oft 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: ADL a� - P7 -*a, SS P / ' PL
•
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 statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
Raul ngeI Ga Nola o9-id - 20 /7
Signature of Owner 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 eptaloyees 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
SITE PLAN APPROVAL I.A%i h C,,te.-ep
Athefcw
DISTRICT l��- ASigt. USE _
$BEDROOMS
Date
V
SITE PLAN APPROVAL
OIS - T i.:- SE' - A '
BEDROOMS 1516. ___ __
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NAME: 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 suhmitted- (Complete site plan=60 months;Complete plus=without expiration)
910-893-7525 option I CONFIRMATION k
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 properly 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.
>0Environmental Health Existing Tank Inspections Code 800
r• 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(sI: can be ranked in order of preference,must choose one.
1_1 Accepted LI Innovative 11 Conventional 1_1 Any
1-1 Alternative Other II
The a plicant shall notif the lot.l health department upon ' bmittal of this application if any of the follotying apply to the property in
questi in. If the answer s"yes", pplicant MUST ATTA f SUPPORTING DOCUMENTATION:
1-1 'S 1-1 NO Does!a site contain any]oris elk al Wetlands'!
1—I S ( 1 Na Do you plan to have an kris? . t ± +.em now or in the future?
1-1Y S 1-1 N n Does o will the building con in any drains?Please explain.
I—}Y'S I 0 Are then any existing wells, prings, ' aterlines or Wastewater Systems on this property?
I !VI S 1—I 1'0 Is any w.stewater going to Ie generate' on the site other than domestic sewag$?
IIY it. I-1 0 Is the site subject to appro .1 by any tit -r Public Agency?
i
11 YE. I—• NO Are there ny Easements it Right of Wa s on this property'!
I1 YE' 1 NO Does the si contain any existing water,c de,phone or underground elect c lines?
If yes pleas,call No its at 800-632-4949 I locate the lines. This is a fr e service.
I Have Read This Application And Certify ' ' e Information Provided 'rein Is True,Complete ' d Correct. Authorized County And
Stale Officials Are Granted Right Of Entry To Conduct Necessary Inspections Determine Comp Race With Applicable Laws And Rules.
I Understand That I Am Solely Responsible For The Proper Identification And Lab• '•• Of , -roperty Lines And Corners And Making
The Site Accessible Sohat A Complete Site Evaluation Can Be Performed.
V'ctul Avkge (Aulcias& 023 16 20/ 7
)OOPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
09109111 Application#
Harnett County Central Permitting
Each ascnon ealvw performing M filled DesiPO Box 85 Lilleplon NC 275/9
byach mewrbalowte NI 9109937525 Fax 9108932783 www Monett or9lpermde
Must M owner or licensed
contractor Address company Application for Residential Building and Trades Penny
name 9 phone must match
Owners Name Date
Site Address 6S Th{- Ln Phone
Directions to job site from Lillinglon
Subdivision ' Lot 1
Description of Proposed Work Skinruf24fL J C – Yowh #of Bedrooms
Heated SF Unheated SF Finished Bonus Roomn_Crawl Space _Slab
General Contractor Information
Building Contractors Company Name Telephone c LO.r'gC2
Address Email Address Q �_ °
License#
glectnal Contractor Information
Description of Work Service Size Amps T-Pole _Yes_No
Electrical Contractor s Company Name Telephone s e O
rel / Email Address
License#��}(
Mschamcal/HVAC Contractor Information
Description of Work
Mei aural Contra—re Company Name elephone
Ad.rase Email Address
Liceme#
PJnmb nn Contractor Information
Description of Work #Baths
Plu bang Contract° - Company Name e°phone
Adtlr - Email Address
License# ,'° t-
Insulatton Contractor Information �y(yf'� 0
Insulation Contractorte Company Name&Address Telephone
*NOTE General Contractor must fill out and sign the second pegs 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 Hamett County Zoning Ordinance I state the information on the above
contractors is correct as known to me and that av aiamna below I hays obtained all subcontractors
permission to obtain these normae and if my 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-6 Months to 2 years permit re-issue fee is 3150 00 After 2 years re-issue fee
is as per current fee schedule
)3Q
1�ta�1 r�1gpl (rrlarzc& o ® - 16 - 20 17
nature of OwnerIC tractorrOfficer(s)of Corporation Date
Affidavit for Worker's Compensation NC G S .87-14
The undersigned applicant being the
General Contractor 1/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
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 pnor
to issuance of the permit and at any time dunng the permitted work from any person firm or corporation
carrying out the work
Company or Name
-SinnwmneR(kU (adctvz4 LJOate 0&- 16- ZP/7
NORTH CAROLINA
HARNETT COUNTY CONTRACT AND AGREEMENT
THIS CONTRACT AND AGREEMENT, Made and entered into this 19 day of June, 2017, by and
Between John Kevin Holder party of the first part, hereinafter sometimes referred to as seller,
and Raul Angel Galarza&Wife Gabriela Hernandez Galindo, 55 Tire In.Cameron, NC 28326, phone#
910-709-9507,parties of the second part, sometimes hereinafter referred to as buyers.
BEING all of Lot No. 1 as shown upon a plat entitled, "Survey of: Gray Fox Subdivision,dated
September 1, 1999, prepared by Dowell G. Eakes, PLS,and recorded at Map No. 99-450, Harnett
County Registry. Reference to said plat is hereby made for a greater certainty of description.
This contract and agreement is subject to the following conditions:
1. The purchase price which the Buyer agree to pay for the above described
property is in the sum of$65000.00,with a down payment of$6,500.00 which money shall
be paid in the following manner:
(A) The sum of$489.00 on or before the 5'".of each month and every month thereafter
until the entire indebtedness is paid in full. There will be a $5.00 dollar late fee per day
for any payments received after the 5th. of each month. All unpaid balances shall bear
interest at the rate of eight(8) percent per annum. Any extension or period of grace
on the part of the sellers shall not be construed as a waiver of any rights herein
expressed. It is agreed that the buyers may prepay any part of the debt without
additional interest or prepayment penalty at any time.
2. Taxes, Insurance,and assessments to be paid by Buyers of property beginning upon
execution of this contract and agreement.
3. The Seller hereby agrees that when the full purchase price has been paid as herein
provided that it will at that time deliver or cause to be delivered to the Buyers a good
and sufficient warranty deed duly signed and acknowledged, which shall warrant
title to the hereinabove property to be free and clear from any and all encumbrances
except taxes and assessments accrued in the year of execution and delivery of a deed.
4. The Buyers agree to pay the said purchase price of said property as herein provided,
and it is expressly agreed that the time of payment is of the essence of this contract,
and that in the event of default of any of said installments provided herein, or breach
of any of the terms and conditions herein stipulated,it shall be lawful for the Seller,
if it sees fit,to declare this contract void, and cancel same, and to reenter upon the
said premises ant any time after such default and take possession of said property,
and all rights of Buyers to shall thereupon cease and terminate,and all sums
paid by Buyers to Seller and all improvements on the property shall constitute
liquidated damages for the breach of this contract, and/or fair rental value of
said property.
IN WITNESS WHEREOF,the parties hereto have executed this contract and
agreement,the day and year first above written. A/ - %�1/ ,o
By:d14 '/(o,— 4s— (SEAL)
----_ John Kevin Holder
liATT ST: _ /'
QQ Raul An 0I GGIOt7V(SEAL)
Raul An Ga rza
(SEAL)
Gab Hernandez Galindo
LYnn•
ie R. Ter
nett County liNC
Mrif
y °mmission Expires
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