DOCUMENTS ri
Initial Application Date: Il I I',Q/i Application# In 5('J"(- acin 1p
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION GA !—.lz ,.�.
Central Permitting 108 E.Front Street,Lillington.NC 27546 Phone:(910)893-7525 ext 2 Fax:(910)893-2793 www.hametl.org/peM�as
"A RECORDED SURVEY
YMMAP,
�RECORDED DEED IOR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN/SUUBMITTING A LAND USE APPLICATION** Pd
LANDOWNER',1 �I , V• �I d ``''// Mailing Address:At ala 5]1yrl 14•11 CH1{,.tJ-)
City: �I`i��n State U Zip e,1,5A'lntact No: r,.� Email:
APPLICANT': W\ ICY\d e1 Calcis( Mailing Address: S S 1-1 Ye LK
City: (ameltn State: NC.Zip:jaContact No: Email:
'Please fill out applicant information If different than landowner //�� 7 p ('�
CONTACT NAME APPLYING IN OFFICE: p ^- Phone# q /0 / 0 / / 5O 7 ,A
PROPERTY LOCATION:Subdivision: 6 -e q r- I - Lol#: I. Lot Size i 'I CAL,
State Road# SS State Road
Name: t.- L{�L n.a._ Map Book&Page: 9c / 4�
Parcel:
:(>11�QG1S b/1 0 f/� ' PIN: ` &L° S- in - LOCKD •cvt
Zoning1ZA 'food Zone_Watershed:Zr1T Deed Book 8 Page: c , _ .flower Company: f•—•-•
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Sizex )#Bedrooms:_#Baths:_Basement(w/wo bath):_Garage: Deck: Crawl Space:_Slab:_Slab.
(Is the bonus room finished?( )yes ( )no w/a closet?(_)yes (_)no Of yes add In with#bedrooms)
❑ Mod:(Size )#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? )
U Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
�❑/'Home Occupation'#Rooms'. Use:rr�� '' � � ����� p_Hours of Operation:
pA a #Employees:_
tip
IV
)C Addition/Accessory/Other':(Sae A OZ,x i ti )UseCestreCA Porcin ciol Ii A...-t Closets in addition?(_)yes (
iillib
(Water Supply: unty Existing Well New Well(#of dwellings using well )*Must have operable water before final
Sewage Supply: New Septic Tank(Complete Checklist) (sting 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 (_)nooI
Does the property contain any easements whether underground or overhead(_)yes (_)no A (� � Y(�
Structures(existing or proposed):Single family dwellings: Manufactured Homes: 1e_ Other(specify): y—..n.ast••�'A� �'
Required ResidentialPropertyLine Setbacks: Comments:�� _ _(� Ca \
Front Minimum Y Actual�14 CO T�PAOC'� ���' i#'
Rear els lir
Closest Side 1 O 43 T ^ , (Y'•fir
dl
Sideabee&corner lot 0291 �a V &(? .• C.. ' Sib \
Nearest Building i in
on same lot
Residential Land Use Application Page 1 of 2 03111
APPLICATION CONTINUES ON BACK
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SPECIFIC1DIRECTIONS^TO THE PROPERTY FROM LILLINGTON: Nv a4 ' P / +t �S • - 1 / K•
LYt
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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.
1�OO Y\I\ ( Ga kr7a o '8-16- 20 /7
Signature of Owner or Owner's Agent Date
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''9t is the ownerlef,plicants responsibility to provide the Pounry with any applicable Informatlun about the subject property,Including but not limited
to:boundary information,house location,underground or oyefhead Basements,etc.The county or Its efT$loyees are not responsible for any
incorrector missing Information that Is contained within these applications."'
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**This application expires 6 months from the Initial date if permits have not been Issuer
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Residential Land Use Application Page 2 of 2 03/11
4, Xj t..0 S4-ci :c-
SITE PLAN APPROVAL 1,xxlto cret
DISTHIC1R :Lo( 1ISE ___.--- roczat-few
9BEDROOMS_._.- -
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SITE PLAN APPROVAL
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MBEDROOMS ` ___ _
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NAME: APPLICATION A:
*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 I CONFIRMATION#
Environmental Health New Septic SvstemCode 800
• All property Irons must be made visible. Place "pink properly 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 aVfor Central Permitting.
• Place orange Environmental Health card in location that is easily viewed from road to assist in locating properly.
• 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.
• Ni lots to be addressed within 10 business days after confirmation. $25.00 return trio 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(liven 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 lnspectlons Code 800
Follow above instructions for placing flags and card on properly.
• 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 UDS 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.
II Accepted I ] Innovative II Conventional I_] Any
1—) Alternative Other
The a plicant shall notif the los%I health department upon • bmiaal of this application if any of the follo4ing apply to the property in
questi n. If the answer s"yes", pplicant MUST ATTAr SUPPORTING DOCUMENTATION:
II S 1—) NO Does .e site contain any Juris• al Wetlands?
1—I S t_jNI Do you plan to have an lsi at'•n - now or in the future?
IJV-S I_) No Does o will the building con •in any rains?Please explain.
IIY.S I1 0 Are then any existing wells, prings, • aterlines or Wastewater Systems on this property?
I_I Y:S I—) r'0 Is any w.stewater going to 'e generate. on the site other than domestic sewag-?
IJY 6. l_l 0 Is the sit- subject to appro ,I by any 01 'r Public Agency?
(}YE. I NO Arc there ny Easements • Right of Wa' on this property?
I_IYE' I NO Does the si - contain any existing water,c.ele,phone or underground elect.c lines?
If yes pleas. call No .is at 800-632-4949 • locate the lines. This is a f. 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 nce With Applicable Laws And Rules.
I Understand That 1 Am Solely Responsible For The Proper Identification And Labe'•. Of - ,perty Lines And Corners And Making
The Site Accessible Sohat A Complete Site Evaluation Can Be Performed.
Raul Yah e) 6ulctrzK og -16- WO
MROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) pDATE
(� 10/10
09/09111 Application#
Harnett County Central Permitting
Each samm Mow
b M orad out PO Boit 65 Lsiknglon NC 27516
by whomeyor padotB work 910 BB3 7626 Fax 910 893 2793 www hermitory/pemne
Must be owner or lienee
sontnaar Address company Application for Residential Buildino and Trades Permit
ammo a phone must match
Owner s Name f Date
Site Address cs "r'*-c__ Ln Phone
Directions to lob sde from LAlmgton
Subdivision Lot
Description of Proposed Work S4L, -t& g..) CAPrce—teorc-in #of Bedrooms
Heated SF Unheated SF Finished Bonus Room,_Crawl Space _Slab
General Contractor Information
Budding Contractors Company Name Telephone c L w. "re
Address Email Address .eveA.rC
f7l..t.Y�1�
License Si
Electrical Contractor Information
Description of Work Service Size Amps T-Pole _Yes_No
Electrical Contractors Company Name Telephone .5t/it'—t.
Address / Email Address
0 Lai
License#
MechantuUHVAC Contractor Information
Description of Work
Me; antral Contra-•r s Company Nam elephone
Ad.retie Email Address •
Licen #
Manama Contractor Information
Description of Work #Baths
Plu burg Contracto Company Name e ephone �—
Add Email Address
License# _ l
Insulation Contractor Information pif" Qr
Insulation Contractor s 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 Hames County Zoning Ordinance I stale the information on the above
contractors rs correct as known to me and that pv stoma below I have obtained all subcontractors
permission to obtain these permits and if psy 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 After 2 years re-issue fee
is as per current fee schedule
-9\4'J Y.NNLL�jQl CnIGrta o S - 6 - to 17
nature of OwnerICBhtractorrOlrsar(s)of Corporation Date
Affidavit for Worker's Compensation N C G S .87-14
The undersigned applicant being the
General Contractor VO er 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 insurpnce to cover
them
Has one(1)or more subcontractors(s)who has their own policy of workers compensation insurance
covering themselves
✓Has rw 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 end at any time during the permitted work from any person firm or corporation
carrying out the work
Company or Name
-,S�gnwrtale Roti V�viel £ ala trip,. t .Date o8- 16-ZoI?
� 1
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 It
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.
By:o %la.— % (SEAL)
✓y�1 /�� John Kevin Holder
ATT STlfrAVIWH F _-
Raul ! n30/ ba/Qi77(SEAL)
Raul An Ga rza
(SEAL)
GabHernandez Galindo
�Ynnie R. Ter
Harnett CoPnblic ry
My Commission Expires )Y' NC