DOCUMENTS initial Application Date: I i {/z n f
Application# I i -,q i I
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION CU#
Central Permitting 108 E. Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.hamettorg/permits
'A RECORDED/ SURVEY MA RECORDEDP � DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION-
LAN DOWNER:
PPLICATION"LANDOWNER: (,��l;G(.b1"' "�j' ` /411.,4
Mailing Address: ,--5;_.....f e' �� �Vc,e-cl
City: /1
State: A Zip "' Contact No: ,-. _Email:
APPUCANT`: ,/ .e,G aiA5,d.MaiIing Address: ,/e.) .i Ax 7a7
City: #4e-e_"7/7 State.. C Ziaci-S, 3 Contact No: 7/D -87Z- (/�E /�
'Please fit out applicant information If different than landowner ��T maii: )QQ'q�/DI'n $ (- �/ j�/�A�,��;
CONTACT NAME APPLYING IN OFFICE: 0./- 04/" . qa- 4i,A. f
� Phone# 7�r 1 r --
PROPERTY LOCATION:Subdivisio 45agfee-/ S
�� I - Lot#: �,3 Lot Size: ".7_ it.......Road# State Road Name. Map Book&Page:,0 _ Z
Igige DU) 1 - 39 - SoLD4.0 : . ? bus_ vCYG
Zoning:, 3MV ood Zone: Watershed: ,f I
Deed Book&Pag Tq7() / 5001 Power Company': ., MI- fIel
'New structures with Progress Energy as service provider need to supply premise number
from Progress Energy.
PROPOSED USE:, ( //
SFD:(Size x� )#Bedrooms:? #Baths3 Basemen wl Monolithic
t( wo bath): GV.'. Deck: Crawl Space: Slab j/ Slab:_
(Is the bonus room finished?U yes ( )no w/a closet?( )yes (__J no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms #Baths__Basement(w.^w:both) Gal age: Site Built Deck: On Frame_Off Frame_
(Is the second floor finished?U yes U no Any other site built additions?U yes (____)U
O Manufactured Home: SW oW TVV(Size x
#Bedrooms: Garage: (site built? )Deck: (site built? )
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
O Home Occupation:#Rooms: Use:
Hours of Operation:
Employees:
O Addition/Accessory/Other.(Size x )Use:
Closets in addition?( )yes U,no
Water Supply. 1/ C unty 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 ( Y )no
Does the property contain any easements whether underground or overhead( )yesno
Structures(existing se Ingle family dwellings: l U
Manufactured Homes: Other(specify):
Required Residential JPP75roperty Line Setbacks: Comments:
Front Minimum Actual W
Rear o2 S 11i�K
Closest Side �0 OZ-161
Sidestreet/ctxner lot 10 --
Nearest Building
on same lot
Residential Land Use Application
Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
114
SPPCi✓;tc DIRECTIONS TO TN PRO:/'TY File LLINGTON: ai '0(A" 7 2
If permits are granted I agree to conform to all ordinances and 1. of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that for=. > g stat- _ is are accurate and/or -. . the best of my knowledge. Permit subject revo on ii false information is provided.
- or
ignature of Owner or tees Age 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
611
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2\i 20' DRA INA L EASEMENT \
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SITE PLAN APPROVAL
DISTRICT V., f 13U USESal S 43" 58' 31.0000" E 105'-0"
#BEDROOMS
J P 1 1 1iry m sva�or 3WE\DOLY\ WAY
CUMBER.AND HOMES, 11NC.
'HE SHI LO n V U M SCREEN PORCH
.J37 * 133 BALLARD WOoODS
SCALE: 11 "Q40 '
A
i
NAME: !i APPLICATION#:
*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)
0-893-7525 option 1 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 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.
❑ 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 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 & 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 {_} Innovative (_} Conventional 1_1 Any
{_) 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 theanswer is`"yes",applicant MUST ATTACH SUPPORTING DOCUMENTATION:
(_}YES {F' ) .NO Does the site contain any Jurisdictional Wetlands?
(_}YES { .iNO Do you plan to have an irrit=ation system now or in the future?
{_}YES (.k1' O Does or will the building contain any drains?Please explain.
{_}YES {NNO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
{_}YES { O Is any wastewater going to be generated on the site other than domestic sewage?
(_}YES {1.-"(N--0 Is the site subject to approval by any other Public Agency?
( V}fES (_} NO Are there any Easements or Right of Ways on this property?
(_}YES ( 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 Un. ' •nd That I Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And. eking
he Site Acc.,.ible So That A Complete Site Evaluation Can Be Performed.
PRS • RTY OWNER ,iR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DA E
10/10
i ccw xl.upfl celow to be lilted out r{ i'.pU.itrcliDn=_
by whomever perforr.ing work. arr.cii Cou i f Central Permii ink
Must be owner or licensed PO Bcx 65 Li9inoton,NC 27546
9 i0-893-?525 Fax 910-893-2793 ,WvJ.harnett.org/permits
contractor. Address,company
name&phone must match
Application for Residential Building and Trades Permit
Owner's Name:
4.114 #441_SiteAddres / - /33 3 1C114-*/, Date: /�? 7
Dir-.,it - Db sit- fr. ' .iir s n•- _,/ ,
i
A%. ter. / �� r� 'r` `"'.t ri_ _
.... .",14.41101F0911121111W—ef.-e--- - .....,-,a1PC
Lr/. !� ,, —_!-/ -�''
Subdivision: �
'� .11U / /
Lot: /3 3
Description of Proposed Work: _45 4-
Heated SF: #of Bedrooms:
Unheated SF: 3/� Finished Bonus Room?
Crawl Space: Slab: !.----
General Contractor Information
Building Ccntr ctor's Company amP
Telephone
'
r ail Address
sin '� cq'�9.
9 ae of Owner/Contra or/Officer(s) of Corporation License#
Dela tion of Work 1 Elec 'ca Contractor Information
- i Service Sized Amps T-Pole:
_ ‘/Yes No
Electrical Contractor's Company Name -9/9 9 K:t9
S -
00/', -k1 /I� Telephone
Addre 4
Emai Address
• ..,f /IMP
Signatu e of Owne ���`�—_//
• r/Contrac_or/0-cer(s) of Corporation
License
Mechanical/14VAC Contractor Information
De 0,goon of rk J / /.:4 �r ' 'cC/
.-r�����
tdiecn r� 9/0` l/�
� cat Lontratt& s Co panty 'amp
• Telept/-"(
Addrew/ / _dor ac)--�� j
/ • t'mail Address
Signature e-/"i . -r •nt -c or/•--cer(s) of Corporation License D #
// Plurmbin• Contractor Information
Description of Work ,(P�
fbVGr— /� � = Baths
9/0-�
-/ ---J///Plumbing on ctorm /2ma Ae. T?lephone
30--4r Pt"d
31 Signature of Ov ./Con or/Officer(s) of Corporation -` e
/I p Insulation Con etor Information se#
Insulation C ctor's Company Name &Address ✓ `5
°/ 1 f Telephone
J /
`NOTE: General Contractor must fill out and sign the second page of this application.
1 2
I hereby certify that I have the authority to make necessary application That the appltcabon is correct
and that-the construction Holl 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
contractor is correct as known to me and that by signing below I have obtained all subcontractors
permission to obtain these permits and if any 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
EXRMIFEES- 6 Mon - to 2 years •erma re-issue fee is 5150 00 After 2 years re-issue fee
s per Cucu ent fee schedule
gnature of Ownertntracler/off.fr s)of Corporation Date//17.47
/dersi
Affidabeinvitg forilia Worker's Compensation NC G S 87-14
The undersigned applicant
General Contractor Owner Officer/Agent of the Contractor or Owner
Do
set hereby the y confirmnitunder penalties of penury that the person(s) firm(s) or corporabon(s) performing the work
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
I them
1.. 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
1 While working on the project for which this permit rs sought it is understood that the Cenhal Peunel:ng
Department issuing the permit may require certificates of coverage of worker s 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
Company art - - 2 / !�/
Sign ;v( Ile //r /e-c:7-"P r gii
L AOf' — Date / /
Harnett County
102 EAST FRONT ST
P 0 BOX 65
LILLINGTON NC 27546
DATE: 11/07/17 RECEIPT #: 0000011227
TIME: 15 : 21 : 19 CASHIER: JBROCK
APPLICATION NBR: 17-50042714
LOCATION ADDR: 91749 TECH 2
REFERENCE: NEW TANK
ITEM DESCRIPTION PAID
SOIL EVAL/NEW SEPTIC TANK 750 . 00
TOTAL AMOUNT PAID: 750 . 00
PAYMENT TYPE: ESCROW
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