DOCUMENTS Initial Application Date 11]I I 1 • / Application# In SOCA au 14
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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_harnettore/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)B SITE PLAN ARE
REQUIRED WHEN SUBMITTING� A LAND USE APPLICATION• ,tet
LANDOWNER IJ'ty IA)i MS Aler,�p Mailing Address: ac cb% bet I. . ck�`v 01
City: 4'T51u" J Sttaate:AJk_Zip:. 1 Contact No.1,4 '7h * Email: k-riBiInk
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APPLICANT*: T -I 14 I in be 1 Mailing Address: 09% 3 &CL (a C•"" 44
City: At+,G( I State:: 6(. Zip:A101Contact No': ell cog ?7Y/4Email: i tai/abohm kAs11. 4oGA
*Piens an oNlpplicant information it(afferent than landowner J
CONTACT NAME APPLYING IN OFFICE: Phone# /('��
PROPERTY LOCATION:Subdivision: Lot#. — Lot
Siizze': •'1�
State Road# 15a State Road Name:'\ �-IO&.ILc CrruVC C-1'U..�h Map Book/A;Page':.\"I`-1S
Parcel:((]]�V��}}�u�� V1.C3ic ) boi-7/ PIN: O .119 TS �.) ''J�T a YCLI! O VV
Zoning:1400 Flood Zone. X Watershed Deed Book B Page: ?. 3 11 DWI Power Company':
'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 w/a closet?( )yes ( )no(if yes add in with#bedrooms)
❑ Mod.(Size x )#Bedrooms_#Baths Basement(wlwo 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?_)
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit.
❑ Home Occupation:#Rooms: Use. Hours of Operation: #Employees'.
piC. Addition/Accessory/Other(SizdSO? Use. ..--- -1--) M S Closets in addition?( )yes (_)no
/
CS,- 54,ara j _ % ere o 1 N Lt+-s-t--
Water Supply: ✓ County Existing Well New Well(#of dwellings using well )`Must have operable water before final
Sewage Supply: New Septic Tank(Complete Checklist) Y Existing Septic Tank(Complete Checklist) County Sewer
Does owner of this tract of land,own land that contains a manufactured home within five hund7d feet(500')of tract listed above?(_)yes ( -1 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 3S Actual](0 K
Rear jaS1
1 OD
Closest Side 11nn 1 t IS
Sidestreet/corner lot
Nearest Building
on same lot
Resident's I Land Use Application Page 1 of 2 03111
APPLICATION CONTINUES ON BACK
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SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: A/0 N✓L)- Sh U'( I UOhj9JU✓) /tet/l z F--}'—
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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 spedfications 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.
/0— y-i7
gnat f ner or neis Agent Date
"It is the owner/applicants responsibility to provide the county with apy 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!l I
NOT FOR LEGAL USE .
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NAME: APPLICATION#:
*This application to be tilled 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 property flags" on each corner iron of lot. All properly
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 pnderarowth 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.S25.00 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 it 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 (II
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 8 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 cyst •pe(s): can be ranked in order of preference.must choose one.
I_I Accepted I—I Innovative onventional ( I Any
( I 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. lithe answer is' ":applicant MUST ATTACH SUPPORTING DOCUMENTATION:
IIYES I NO oes the site contain any Jurisdictional Wetlands?
( IYES {M**D� Do you plan to have an irrigationsyst_€m now or in the future?
I—IYES I SI'NC) Dues or will the building contain any drains'!Please explain.
{ vicES 1I NO Are there any existing wells,springs. waterlines or Wastewater Systems on this property?
IIYES ( OO-fl Is any wastewater going to be generated on the site other than domestic sewage?
I—IYES LAWINC) Is the site subject to approval by any other Public Agency?
( IYES Il- l<1O Are there any Easements or Right of Ways on this property?
I (_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 locale the lines. This is a free service.
I Have Read This Application And Certify Thal The Information Provided Herein Is True,Complete And Correct. Authorized County And
Stale 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 Site Accessible So That A Complete Site Evaluation Can Be Performed.
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PRYyOrNE OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
•
09/09/11 Application#
Harnett County Central Permitting
PO Box 85 Ltlbrpton NC 27546
Earn section below to be lilted out 910 B93 7525 Fax 910 893 2793 www Monett org/pennta
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name 8 phone must match
Owners Name Ty IND iwlher)y Date )0-0211`17
Site Address 254 3 Oa/t- 6-ewe- Glp 4.,), et" Phone 914 464 7)
Directions to Job site from Lullington 210 - <h,n l-I- , yob 0Jw, Rd Ief-1- ai)
Dais mire— C-ht,fiin
Subdivision Lot
Description of Proposed Work #of Bedrooms
Healed SF Unheated SF Finished Bonus Room? Crawl Space _ Slab
General Contractor Information
Building Contractor s Company Name Telephone
A.�d�dres��s-A,n`- _ Emai Email Address
License#
Pacifica! Contractor Information
Description of Work Service Size Amps T-Pole _Yes No
Electrical Contractors Company Name Telephone
Address Email Address
r71�J✓�-�l� _
License#
Mechanical/HVAC Contractor Information
Description of Work
Mechanical Contractors Company Name Telephone
Address _ Email Address
pt.(
License#
Plumbing Contractor Information
Description of Work #Baths
Plumbing Contractors Company Name Telephone
Address Email Address
License it
Insulation Contractor Information
Insulation Contractor s Company Name&Address Telephone
'NOTE General Contractor must fill out and sign the second page of this application
C
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 sianina below I have obtained all subcontractors
permission to obtain these asrmrts and if pay 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-0 Months to 2 years permit re-issue fee is 5150 00 After 2 years re-issue fee
is as per current fee schedule
/O Z'-1-1?
Signatu t ontractor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation NC G S 87-14
The undersigned 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
77ov ria 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 during the permitted work from any person firm or corporation
carrying out the work
Company or Name)
Sign w/Title /3 / 4/nv Date /0- 21'/`7
HARNETT COUNTY CASH RECEIPTS
UPer: JBRDCB CUSTOMER RECEIPT ate
E
Date: 18/24/17 52 Receipt no: 128171
Year Number
2017
91749 TEC 58842614 Amount
LILLINGTON 2
64 Bp 27546
NEN TANK -
ENV HEALTH FEES
$758.BM
WTNERBLY BUILDERS
Tender detail
CP CREDIT CARD
Total tendered f750.BB
Total payment f75B.BB
Trans date: 18/24/17 $750.80
ea THANE YOU FOR YOUR PAYMENT as