DOCUMENTS Initial Application Date: ` Application# 1JriTh
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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.hamett.org/permits
"A RECORDED SURVEY MAP,RECORDED� DEED(OR OFFER TO PURCHASE)8 SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER: `. r3.44.t4* t(+.. /BOOS Mailing Address: `SLob he E
O
City: Mt CS State: NC- Zip: Zfl'<Contact No: 113 'SL>�%SIF1 Email: SLI#%QQS"lf(y.Cprl}t pcynA..
APPLICANT': p•'si Mailing Address'.
City. State: Zip: Contact No: Email:
'Please fill out applicant Information if different than landowner log
CONTACT NAME APPLYING IN OFFICE: -AST tuft�` Phone 9W 3c LS3q
PROPERTY LOCATION:Subdivision: C6WMr'L n LOC.," Lot#., 491 Lot Size. •3C ac:e�
State Road# State Road Name: QL . !I nq 1 Map Book 8 Page: 3531 / 0331
Parcel: 079516114 OLIY{'1 PIN: -t SS' " y4- 0,8)
Zoning. ' Ce
Flood Zone: — Watershed':- Deed Book 8 Page: - / Power Company': tTt14I Ciente
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: ,,II
SFC:(Size 31 x tip )#Bedrooms':'4 #Baths2'Basement .wlwo bathMonolithic
( )_Garage. Deck: Space: Slab. Slab:
(Is the bonus room finished?(_)yes ( )no wl a closet?(_)yes ( )no(if yes add in with if bedrooms)
❑ Mod:(Size x )#Bedrooms 4Baths Basement(wlwo bath)_Garage:_Site Built Deck:_ On Frame Off Frame_
(Is the second floor finished?O yes (_)no Any other site built additions?(_)yes ( )no
U Manufactured Home:_SW_DW_TW(Size x )4 Bedrooms: Garage: (site built? )Deck: (site built? )
❑ Duplex:(Size x )No.Buildings No.Bedrooms Per Unit:
❑ Home Occupation#Rooms: Use: Hours of Operation: #Employees'._
❑ Addition/Accessory/Other:(Size_x_)Use: Cbsets in addition?(_)yes (_)no
Water Supply. Lei County Existing Well New Well(#of dwellings using well )'Must have operable water before final
Sewage Supply: New Septic Tank(Complele 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(5001 of tract listed above?1 )yes (LI no
Does the property contain any easements whether underground or overhead(_)yes (')no
Structures(existing or proposed):Single family dwellings. ' Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum 3C Actual 3e
Rear 2o 0,1011
Closest Side 10 "SO
Sidestreeuwmer lot
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:
LeFl- on NC 7_, 1/40
Le IV or. at{ ato takt< Qct
br On Cuov04, Lea4..c Rb
LefF Lam _ ..
Let a?Qt '1 14 ewttcc on le-ff
If permits are granted I agree to conn . • - • • -nces and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing s ants are accu • •rrect to the best of my knowledge. Permit subject to revocation if false information is provided.
y_ fT-0
"or'. of Owner• r er's •ant 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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Vicinity Sketch - Not to scale
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Ca b a -F IPS iron pipe set
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\\• At 4f.�. SIR rat Iron rod
{O `0�' �� BSL 710 Nrbaak 9M
0 70y '400' P9. Pala BOak
Proposed CD
ae', I e
4 ` 5 3677.36' W
,/ r 5, 450' 19.30'
200' 2.00' k
/ ,4, 467 Lot No. 495 yj mm
9bek R vr. \ m
/ Carolina Lakes. Phase S/xa N
r "v Cabinet 0, Plot 57-C 4 R
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4 Leland 0. Stator, or* MN OM plot a Own by nc that eta rnop o not prepaid from
an oolong Had survey a boundala Mw an Oven from Mfamwam found M Exara,S at
record w noted broom a£... Jala as SLAW to Orange upon pliffannance ce a fad sena..
rw-DDadra **nature and sea' Ws Jiat of Ann& 2077. 01111111110
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Wood 0. Stater, PLLS L-2780 4.•.` 4;1•�FEBB....Z/p t:-
aitarse.— ON .0;
Site Plan for r SEAL =
...1.:101.1:8 • _
Southeastern Construction of Rockfish �,�e •`,r. �
Lof No. 495, Block R, Carolina Lakes, Phase Six ' % 74111111110‘�````�
Barbs qua Township, Harnett County
North Carolina
Scale: V =50'
Strother Land Surveying, Firm No. F-0505 trLaee
kqf Amu50' 0 50' 100' 150'■ ■ ■ ■ ■ a.��e
■ ■ ■ ■ ■ �GRAPHIC SCALE — ONE INCH = Frry FEET "oma
09/00111 Application#
Harnett County Central Permitting
Esti section below to be Med DistPO Box 65 Winton NC 27546
M whomever performing work
910 893 7525 Fax 910 893 2793 www Mmett arpipermns
Mise be owner or licensed
contractor Addfess company AODIICatlon for Residential Budding and Trades Penny
name 6 phone must match
Owners Name So..rt.egtur Cortshr,on*, Date Cr 13-1-1
Site Address 3113 CQ.ruhrr.t_ W+. Phone
Directions to lob site from Edlington Left- or, Nc 2-T W • La 11 o.. B..f4cii
La11.ts 2d lift• on Cunt.... Li1Ltc R-4 ; Le{i-
OM Cc io%in.. ts/t Let- aQrruY 4 intl., Oh tic-1/4
Subdivision Cu e\,Ac. 1.clu_c Lot Lfl
Description of Proposed Work Nt.o Res CarrcF . #of Bedrooms 4
Heated SF ZOt$P Unheated SF Squ/ Finished Bonus Room'i PO Crawl Space _Slab Ve
Generat ContractorraMInformation
SJ...tt.t asiClh Cun.ctr Aiir -Neff( '&t j q,0 3orc 1531/4/
Budding Contractors Company Name Telephone
'ill i&sk C Rd Q..o(a,rd N . 2.1311. sok ec vtt(n const awn:- t
Address Email Address
5311-1
License#
glectncal Contractor Information
Description of Work peva, Cwvst Service Size 2i30Amps T-Pole /Yes_No
iLktia Docket Ala BIR C4gN
Electrical Contractors Company�,, Name Telephone
�% 1?e.n 'Orice truth $C- z834P
Address Email Address
1S1Log-
License#
MeehanicallHVAC Contractor Information
Description of Work Oa) Ce,.st
Cet+t4;eA ‘k /Pr qk7 %SS 0000
Mechanical Contractors Company Name Telephone
90 eels jolt Hope 1'NV% 14L t%34%
Address Email Address
2.13‘31z - I+iCI
License#
Plumbing Contractor Information
Description of Work 146v4 CO, k #Baths -a• c
tow, .bate a. "Fru. tY 1I0 - 919 - 3288
Plumbing Contractors Company Name Telephone
Lpt'l csi 'porn,t.� fit• tcy . 2-1531‘4
Address Email Address
2"101% 1?- 1
License#
Insulation Contractor Information
Tt. Cit 3'� E. 41.Mt+a:,, bf. cos 9JO v11. sssr
Insulation Contractor s Company Name&Address 21g�C Telephone
*NOTE General Contractor must fill out and sign the second page of this application
I hereby certify that I have the authonty to make necessary application that the application is correct
and that-the construction will conform to the regulations in the Building Electncal 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 pv stantna below I hays obtained all subcontractors
permission to obtain these Demote and if pm 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-6 Months to 2 years permit reissue fee is 6150 00 After 2 years re-issue fee
is as per current fee schedule
')- /2- r7
Signature o • .. - o _ 'o • aer(s)of Corporation Date
•
Affidavit for Worker's Compensation N C G S 87-14
The undersigned applicant being the
General Contractor i- 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 -^-saNtesit rr.
Sign wRNe__.�� (hnrr-f Date 9-a- 17
Appointment of Lien Agent: Details - LiensNC Lien Service Page 1 of 1
DO NOT REMOVE!
Details: Appointment of Lien Agent
Filed on: 09n3n017
Entry Y: 720297
Initially nl,d by: soulhaegbrncotnt
DesIgnabd Linn Ag,nt Prolact Prop,rtY
Print & Post
BLEny Nsnnnal I Company,LLC PIN 95954607PS
3171 CAROLINA WAY
(bliae:,n llama Lyn SANFORD,NC 273132 '- N
4ddrns:In W Manna Si. amp L17I Raleigh NC I IARNETT Conry O _(-Yea
Coat roams:
Phnom dggl#Iaxi Pleas n am notice on the lob Site
nt.vwdvanl Property Typo
Suppliers and Submntnetan:
gmalt.5yypalylennemm Sean ibis image with your smam phone to
cw Ibis Nmg You can Mtn Plea Notice
-2 Family Duelling to Lien Agent For this Prolan
Own., In(orm.tIon
Dal, of First Furnishing
SOUTHEAS FERN CONSTRUCTION
Ill WOSTIC RD
RAEFORD,NC 28376 09/1 T2017
United States
Email
SOLI I IIEASTERNCONSTI('@OMAIL COM
Phone 910.308-1519
\Nen Cornmeth10/
Technic.'Support Hotline:(888)690-73S4
https://apps.liensnc.com/scr/appointment/details.html?entryNumber=720297&printable=Y 9/13/2017