DOCUMENTS Initial Application Date: 1I ( 1 I' Application# I. - `5Cz '`-"R 7 .4
CU#
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.harnettorg/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER:MR Constructors of Fayetteville, LLC. Mailing Address:2919 Breezewood Avenue, Ste.400
City: Fayetteville State'.NC Zip.28303 Contact No: 910-486-4884 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
#9104864864
CONTACT NAME APPLYING IN OFFICE:Leanna Hair Phone
Oakmont Lot#:I nye CI Lot Size:it3acre5
PROPERTY LOCATION:Subdivision'. �''7
State Road#((1116 (] State Road Name: Docs Road � /M�a�p Book 8 Page � `I
Parcel: aOPJcl—lo I Loa I a a PIN: NO).-14(4 l33LJ
RA-20R ,[�( ^�,�/� Central Dec.
Zoning'. Flood Zone'.. Y. . Watershed:/orf Deed Book 8 Paget77� /1591 Power Company
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED U''S/IE: Plea)Av O ,// Monolithic
i6 SFD':(Size"-Mit x #Bedrooms:y #Baths:Basement(w/wo bath):_Garage: Deck. Crawl Space:_Slab_Slab_
(Is the bonus room finished?(_)yes ( )no w/a closet?( )yes (_)no(if yes add in with it 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?(_J yes t 1 no
❑ Manufactured Home:_SW_DW_TW(Size x )#Bedrooms: Garage: (site built? 1 Deck. (site built?_)
❑ Duplex:(Size x_)No.Buildings: No. Bedrooms Per Unit:
O Home Occupation:#Rooms: Use: Hours of Operation: #Employees:
❑ Addition/Accessory/Other:(Size_x 1 Use: Closets in addition?( )yes ( )no
Water Supply: ✓ 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(500')of tract listed above?(_)yes 11)no
Does the properly �17 noy contain any easements whether underground or overhead( 1 yes (
Structures(existing or proposed): Single family dwellings:Proposed
Manufactured Homes: Other(specify)'.
Required Residential Property Line Setbacks: Comments:
Front Minimum 35 Actual 1 /i I 'f
Rear 25 I^Qe e
Closest Side 5/10 air
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 agr q 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 tatements are accurate and ct a the best of my knowledge. Permit uect rae tion if false information is provided.
,`SSiiLggJnatture,orf Owner or Agent (_1] Date
***It is the ownerlapplicants responsibility to provide the county with any applicable informati
about subject
epproperty,re not responsibleng fort limited
to:boundary Information,house location,underground or overhead easements, The county Its employees
ny
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
A MICHAEL P. GRIFFIN , certify that under my devotee and .
stprMLm this map was ahem from an actual Herd anise that the STOP o/ p2 �
closure a/Mt survey as calculated by co>exateS Is I. /4W01 : mat the Q
no Nem hereon was calculated by coarttee. t9iL 9d
Whims my hand and seed this day of MOW20 1-y4V L
FUTURE DEVELOEMEDT
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SETBACKS
FRONT
REAR 25
SIDE 10'
REVISION LEFT RAND SIDE ENTRY. BACK, LEI`T 8z29/17
CI R=1155.82' L=115.05' S28°1728"W 115.00' .242
1 LEGEND
NAME:I 5".ti er rl)G�)Krs� Ck + ' CCC ' APPLICATION#:
*This application to he 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-S93-7525 option I CONFIRMATION#
i 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 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.
o 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
niven 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 (_l Innovative {11 Conventional ten Any
{ I 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:
{_DYES (XI NO Does the site contain any Jurisdictional Wetlands?
{_}YES Ot) NO Do you plan to have an iout Stem now or in the future?
{ }YES (Z( } NO Does or will the building contain any drains?Please explain.
t )YES {Kt NO Are there any existing wells,springs, waterlines or Wastewater Systems on this property?
( }YES (_I 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 pe} NO Are there any Easements or Right of Ways on this property?
(_DYES {j} NO Does the site contain any existing water,cable,phone or underground electric lines?
If yes please call No Cull 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
The Sit ccessible So That A Co Ile Site Evaluation Can Be Performed. 3 n
PROP RTY WNERS ORO RS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DA E
10/10
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09109111 Application#
Harnett County Central Permitting
PO Box 55 Lillington NC 27546
Each section below to he filled out 910 13133 7525 Fax B10 893 2793 www harnett erg/permits
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Budding and Trades Permit
name&phone must match
Owners Neme�r11}�}�� e...0%-y ,O,t,`�y�il},,rCC-f6i`� ' EA-1/4V.I llf� t(IL • Uat
31
4Slte Address &na 146a-her brlve) Phone Cl IO"' 43b - LIV'loy
Directions to Job site from Lillington t C\tf✓ L1A. a I -tn oaf,- I2r)aC'\
\e4*pcr:.b3Ct \Th cc \ES -. --curt-) \e-t ltlin
`'l Stdll .
Subdivision >"Li/j nry -
� . y
Description�ro�ffp Proposed Work N1L to )iiVJ�.. CCM)r�1J j )cu it u1t3 # f Bedrooms Li
%Heated SFni%5a Unheated SF Stile Finished Bonus Roomy Crawl Space Slab
General Contractor Information
F H eonN-ruL.tOry (.4- Vc4.40eu; llE-Ll(` . C. t& LI Ste- c181vc1
Building Contractors Company Name Telephone
: cl lci S.3)reeze.,..c. d ra/ he asis Leto-Nati-lair
Address Email Address
r7 L-i 1(51)
License#
Electrical Contractor Information
Description of Work Service Size ,'�(X�4mpps T-Poler1✓(i -IYess�]_No
C• t c e, t C' ' _ �. i . �il CI 1()- �13-- U �(NJC)
Electrical Co rector s 7 pan Name Telepho e
LISA OCAl-kehead L(Vul Fzy, 1JC ac')Id '1)lance-pa ic .Q(301
Address Email Address
0%1100- L
License#
ptechanical!HVAC Contractor Information
Description of Work
Cur.-dine Cnrrshr+ A1r.itclC, . qlr 1:16y- IIaIrO
Mechanical Contractors Company Name Telephone
7O V); L c yt Tt) Ne. 01-154 ('arohrciinn 4o*-i-Airtyaht ,coin
Address Email Address
r1O71 H
License#
Plumbing Contractor Jnformationay_
Description of Work $Baths 3
Dell Oct're. 7\‘.\c"\:).1 CII)` CI - en3et
Plumbing Contractors Company Name TAInnhone
prlf,yk1c`Xxic' t.030 ,co.v, � 11tiaePunnrrPhnfwi,l ,C0nel
Address 3 Email
License#
Insulation Contractor Information
IrlciiU �nSulciton +x . yiS PF rS ) >t. � J 11� L1�54. `i'ir/)
InsulationlContractor s Company Name&Address 33,-3,)j 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 sranina below I have obtained all subcontractors
permission to obtain these permits and if oma 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 a er current fee schedule
� ¢, q ` I3` 11
Signature of Owner/Contra Officer(s)of Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The undo 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 during the permitted work from any person firm or corporation
carrying out the work / I,�
Company or Name lit N (J &1-ieC4ccS �'cj&t. r lief LLL
ign w/Titl &LtA& AA) /E'rn ccc irtj C c t' a cnccDate413I ii
Appointment of Lien Agent: Details - LiensNC Lien Service Page 1 of 1
DO NOT REMOVE!
Details: Appointment of Lien Agent Flied on: 08/28/2017
Entry #: 711057 Initially filed by: meegenbredshew
Designated Lien Agent Project Property Print & Post
Yon Amerman Am Insurance Company OPM000Ig9 Lot lag Oakmont Ear
ne
202 HEATHERWOW DRIVE -
Onllan Mame coma -- ' Lllinglon,NC 27546
Aaamnl 9W Hanoi 9Aoue 547 gameR NC Harrell oonlY Q
216111 Connector,:
Ph nee.tS0 wrv➢xe Please post thin notice on the lob Site
Fe.:411-952- Property Type
Suppliers and Subcontractors:
Emve yyp®ndlutun•sm --- Scant Lis image will your smart phone to
w this filing You can then file a Notice
18 fancily Dwelling to Lien Agent for this project
Owner Information
Date of First Furnishing
H&11 Constructor,of Enyoterale,LLC
19 ntevewnoe Avenue Etc 400
Fayetteville, NC 20202 06/26/2017
Untied Stales
Email leannalltit@hhhomes cum
Phone 0 10-406-4864
V ew Commm¢(01
Technical Support Hotline:18881696➢04
https://apps.liensnc.com/ser/appointment/details.html?entryNumber-711057&printable= 9/20/2017
Date l )
Plan Box # t T� Job Name 1 7 ? .11
Plan Name /� l
App # -a3q a Valuation#37 )/ 792 SQ Feet 02GD..5�
Garage 474a/
= 3a 73
Inspections for SFD/SFA
Crawl_ Slab_✓/ 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
Foundation Survey_ Envir. Health J Other
Additions / Other
Footing_
Foundation_ /^.
Slab_ No zss
Mono_ /CS
Open Floor_
Rough In
Insulation_
Final