DOCUMENTS Initial Application Date. 1FIJI, 1,1 Application# In SCJl)kYeL 1 J I
CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillingtan,NC 27546 Phone. (910)893-7525 ext:2 Fax (91 0)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:H&H Constructors of Fayetteville, LLC. Mailing Address:2919 Breezewood Avenue, Ste.400
City: Fayetteville State.NC Zip_28303 Contact Nc: 910-486-4864 Email: leannahair@hhhomes.com
APPLICANT':H&H Constructors of Fayetteville, LLC. Mailing Address:2919 Breezewood Avenue, Ste.400
City: Fayetteville State:NC Zip:28303 Contact No: 910-486-4864 Email: leannahair@hhhomes.com
'Please fill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE:Leanne Hair Phone#9104864864.6� K /�/'
PROPERTY LOCATION:Subdivision,: Oakmont Lot#: Isv ) Lot Size: 1F)IQC
1116 Docs Road Ma Book&Pa e9 �lol In
Parcel: 61
State Road# State Road Name: �/� 9
15 Ic13 I 10a, IT PIN'. 06001 —/�4�yy -"•5* ?
Zoning'.RA-20R Flood Zone: Watershed'. Deed Book&Pag wer Company: Central Elec.
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USEI IM��!�f Q Monolithic
14 SFO'.(Siz O WO')#Bedrooms_#Baths._sW Basement(w/wo bath): Garage: Y Deck:_Crawl Space:_Slab. Slab:_
(Is the bonus room finished?(_)yes (_)no w/a closet?( )yes (_)no(if yes add in with#bedrooms)
❑ Mod:(Size—x1#Bedrooms #Baths_Basement(w/wo bath)_Garage:_Site Built Deck'. On Frame Off Frame_
(Is the second floor finished?( 1 yes ( )no Any other site built additions?( )yes ( )no
❑ Manufactured Home:_SW_DW_TW(Size x lit 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: Closets in addition?( )yes ( )no
Water Supply I County Existing Well New Well(#of dwellings using well ) Must have operable water before final
Sewage Supply. I 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 property contain any easements whether underground or overhead( )yesno
Structures(existing or proposed):Single family dwellings:Proposed Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: / Comments:
Front Minimum 35 Actual !` i
Rear 25 ^Oyo
Closest Side 5/10 �(, '•
Sidestreet/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: Take Hwy. 27 to DOCS Road,turn left,go about 1.5,turn let into
subdivision.
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 foregoi atements are accurate and c re t to the best of my knowledge. Permi ct to re ocation if false information is provided.
Signature of Owner or r s Agent Date
"'It is the owner/applicant,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 03I1 1
t. MICHAEL P. GRIFFIN . certify that undermy dkdctlaa and $'�A50
euarw ta+ this ma, was drawn from an actual Meld sunex Mat the error aT9�dti
ar
closure of the saw as calculated by coordinates Is I: taacoe: that rise -OCL
area Maes nrm was calculated by car&nareaP'OA '
Maness my hand and ser this day of MONTH 2O17 -D\gJ
Iteel
FUTURE PtVELOFMEN1
5 383242'W— 100.00
WEIIANDS
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11EATI-IER WOOD DRIVE
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S E T O A C K S
1KONT 35'
KFAK
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REVISION. LEFT RAND SIDE ENT KY, BACK, LEFT 6I29i 17 1242
1 LEGEND
NAME:f -11 (
{% c ITeIr W.S. f,F Fct_j ' /IC ' APPLICATIONS:
*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 l CONFIRMATIONS
Dr 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 tee 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 ltd 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 t-I Innovative 111 Conventional Ill Any
t_1 Alternative I 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:
{_IVES IX) NO Does the site contain any Jurisdictional Wetlands?
t—]YES t>1 NO Do you plan to have an n system now or in the future?
(_}YES {Lt ) NO Does or will the building contain any titans?Please explain.
{_)YES ICI NO Are there any existing wells,springs, waterlines or Wastewater Systems on this property?
{_]YES {1,J NO Is any wastewater going to be generated on the site other than domestic sewage?
{_)YES til NO Is the site subject to approval by any other Public Agency?
{_)YES JfNO Are there any Easements or Right of Ways on this property?
l_lYES 1±-1 NO 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 Understand That I Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
'1'1�{�'ttto AAccccccees/siible`'SSoo T�h`att^A Co pl to Site Evaluation Can Be Performed. n
PR[IPERTY OWNERS OR 0 RS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) t� ATE
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09109111 Application#
Harnett County Central Permitting
PO Box 85 Lillmgton NC 27546
Each section below to be Mled out 910 893 7525 Fax 910 893 2793 www harnett aria/permits
by whomever performing work
Must he owner or licensed
contractor Address company Application for Residential Budding' and Trades Permit
name 8 phone must match
Owners Name^IAvE,�t"1 e-Uc�. o rtC-t-31— • Uri
E'HP4•t IIc •ILL - • tate aft 11
-Site Address,a flQ at ►•- 3d Ur Phone C , - : (cLt
Directions to lob site from Lillington t nX e Leg I I -fc" A Jl)C i c2_c C\ *or n
l
QA--t r'ebaL \t3 S`ri\E`:.) . \ L1e- * fcitc
Subdivision ctif�V'11!l(Y+ xn
Lett J
Description
rro��frProsed Work Me LLSI t�1C. �-Cifll,lff ��LCA'.I�Illrj #bf Bedrooms 14 l'
%Heated SFd`r QUnheated SFLOn.-Finished Bonus Room? - Crawl Space Slab V
General Contractor Information
i% H C'nrl` 'ruttcirs cit Fc /€*kV1IIEL-1 . qi)- U SID- i%iii
Building Contractors Company Name Telephone
1Lilri 6reezeAve lc,Lfl �ri . /JO c')&3„.13 Lec:nr J-hir PMI c rr* Lc9v
Address Email Address
7y I3%
License#
Electrical Contractor Information
Description of Work Service Size ; iLiAmps T-Pole _Yes No
>[ t'lc\llk\C�C\c ( ec,,-tFir' �-ilC. , cit()- 3().-3- 34139
Electrical Contractor s C p,1anx Name Telephos�
4r>Ll 1,o�l(k&.1' eftd &nod Fay. riC' &3;-1; 71ru e-Ai Ylfl�lt\SCLlrX+f-iC .C)11
Address Email Address
OW160- L
License#
Mechanical/HVAC Contractor Information
Description of Work
(
l GConic-art- Ai rTeleJog- I)(.1C)
Mechanical Contractors Company Name Telephone
� ClaNtc)i) N('. J-15-)3 str>>lirc �nns�u�+lirQyra.�,loria
e1 �A�y �1nt),ati
Address Email Address
Q`10-11 N -3-
License#
plumbing Contractor Informationak
Description Work #Baths •O
De11 t1ntri'. \�\rrnb'tf % `yCI - cg3C1
Plumbing Contractors Company Name Taianhone
1ne-f-A aT 4g Lc3')L IIf l te'_`S* ku) NC, Deilthae9surr a mrutA °'
Address ..454 Email
c25d2SteP - i
License #
Jnsulation Contractor Information
I rlci*q J iv)ulc+un�rx 114 PrrSN)C%t. Fi:1/ ILII.. en- hS4;-
InsulationtContractors Company Name &Address ;13,331 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 sign ma below I have obtained all subcontractors
permission to obtain these permits and if ary 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 re-issue fee is$150 00 After 2 years re-issue fee
is er current fee schedule
Lacca a nt ffffd_ Oa h
Signature of Owner/Contractor icer(s)of Corporation Oat
Affidavit for Worker's Compensation N C G S 87.14
The uncle igned applicant being the
General Contractor 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 prior
to issuance of the permit and at any time dunng the permitted work from any person firm or corporation
carrying out the work
--
Company
Company •vame /1t. N (. S+'{-1 C+31—S - V-Cart I I lc LtS... . �/y�
&gnwrn \ 0 I ' I /1Efryir*`irf'j�ur1/4 Pat-Date Date Ot_iI 11
Appointment of Lien Agent: Details -LiensNC Lien Service Page 1 of 1
DO NOT REMOVE
Details: Appointment of Lien Agent Filed on: 00(2812017
Entry #: 711113 Initially filed by: meaganbrad.hew
Designated Lien Agent Project Property Print a Post
Fun Ametiren Tale Insurance Company O12M000155 Int len Oakmont El El
282 I IEATHERW000 DRIVE
(• ryr
PiSth. lav Wnmc cam Wllmtlmrt NC 27546 {e••i
Mame JW Hansen Si So 51iWingh,NC Harnett County 0'! a
27601 Contractors:
Phone:8118.690-71N4 Please post this notice on he lob Site
pe..913-nhsln Pro Party Type
Suppliers and Subcontractors:
Fmnil:
math uhmme cum -- Scan Ons image with your an phone
new tthenis filing.You n file a Notice
w
1-2 Family Helline toLien Agent for thispmlect
Owner Information
Date of First Furnishing
Hill Constructors of Fayetteville.LTL'
2919 E reertaond Avenue Ste 400 06/26@01]
Fayetteville, NC 2530]
United States
Email leannahairi hhhomrsclam
Phone 911H56-4564
View Cmnme:s(01
Technictl Support Hotline:(888)690-7)54
https://apps.Iiensnc.com/scr/appointment/details.html?entryNumber=711113&printable= 9/20/2017
Date G l dl.o h el
Plan Box # e1 Job Name }�
Plan Name 15; 14 m_mire
App ## 4D.3t t Valuation 4 316„W? SQ Feet o?qJ o7
Garage OS
= X ?7
Inspections for SFD/SFA
Crawl_ Slab V Mono_ Basement_
Footing Footing Plum Under Slab Footing
Foundation . Foundation Ele. Under Slab Foundation
Address Address Address Waterproofing
Open Floor Slab Mono Slab Plum Under slab
Rough In Rough In Rough In Address
Insulation Insulation Insulation Slab
Final Final Final Open Floor
Rough In
Insulation
Final
7/7
Foundation Survey_ Envir. Health Other
Additions / Other
Footing_
Foundation_
Slab_
Mono_
Open Floor_
Rough In
Insulation_
Final_