DOCUMENTS Initial Application Date: N11011 in S Application# I 1�.7�-�] I (�w�
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COUNTY OF HAR EAPPLICATION
��C.ertaall Permitting ^y� 1081E.Front et,Lillington,NC 27546 P one:(910)18893-7 exC2 Fax:(910)893-2793 w.vw.hametl.orglpermits
^A RECARDEEQ SMVEY\M_IlY,REC D EEDORFFRTOPUCH E)E3REPLAN1iE REQUIRED
D�WHEN SUBMITTING A LAND USE APPLICATION^
�g' �,sJ'hi02!-'L+r` 100-6 Mailing Address: PO. 8ZY 1a )
City: Dk-)n n State:PL zip: 2b'st1- Contact No: `t 15 ct Li 4 t L4 Email:
AMICIMITI: Scr n C- Mailing Address:
City: State: Zip: Contact No: Email:
'Please fill out applicant inbtmavon if different than landowner
CONTACT NAME APPLYING IN OFFICE: n``ic tp 13 Pr
l 1e,-, Phone# l \�i `k ti �-1 »,t� [
PROPERTY LOCATION:Subdivision: \`e-S WO 'rte n Lot#. Zo Lot Size: '-f -[
State Road# �� State Road Name: RO\ \ s!'\'s yc sQ. 1 �, 1 , `1 - lMap Book
,8Pa1ge-pe-+I C0/ ICO
Parcel:f.fy V� S DI Oc PIN: D Lo�-C Sip—�L'LN.fI--I,Lo Lt LO
Zoning y(rP-? Flood Zone:% Watershed:PA Deed Book 8 Page: S�esL�.bot•1 Power Company':
*New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: Y4630-
�ff /Sabnlldllc
SW'SW:1S¢eL��1#Bedrooms:3 #Baths:y Basament(wlwo bath):_Garage:_Deck: Crewl Space: Blab._VVV Sllab:_
(Is the bonus room finished?( )yes ( )no w/a closet?( )yes ( )no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms ft 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?( )yes (_)no
❑ Manufactured Home:_SW_DW TW(Size x 1#Bedrooms: Garage: (site built?_)Deck: (site built?_)
❑ Duplex:(Size_ _)No.Buildings No.Bedrooms Per Unit:
U Home Occupation:#Rooms: Use: Hours of Operation: #Employees'.
❑ Addition/Accessory/Other.(Size_x_)Use: Closets in addition?(_)yes (_)no
Water Supply: YCounty 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 (_)no
Does the property contain any easements whether underground or overhead( )yes (—lino
Structures(existing or roposed): -ngle family dwellings: 1 Manufactured Homes: Other(specify):
Required ResidentialPropertyLine Setbacks: Comments:
Front Minimum '1s Actual 4L0
Rear r _ is�/''�
Closest Side `/p _J—O Y
Sidestreet/corner lot
Nearest Building
on same lot 03111
Residential Land Use Application Page I of 2
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
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 foregoing s Cement accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
I11µ117
Signa ner or Owner's Agent Date
"9t 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 overhedd easements,etc.The county or Its employees are not respbnsible 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
•
S 71° 34' 40.0000" E 701'-15/16.71° 33' 49.0000' E 55'-8 7/8"
15' S TREETSCAPE BU FER
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SITE PLAN,�APPROVAL
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DISTRICT1_L>� USE I o
*BEDROOMS sHiliall .\
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R=335'-0" N 71� 42' 53.0000' W
AL-73'-15/16" 2T-2 3/16'
it:::Pdmitistraer
TROPHY RIDGE
CUMBERLAND HOMES, INC.
DV VV/ 3RD
THE SALEM CAR GARAGE
L It T * 20
SCALE: 1"THE RESERVE
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NAME: C'/`/*` •Lt- I Dis->C APPLICATION d:
*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)
910-893-7525 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 underarowth 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 reauest.
• Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
Environmental Health Exlstlna 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 hit 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
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 typctsh: can be ranked in order of preference.must choose one.
IJ Accepted I } Innovative I<CConventional 1—I Any
11 Alternative I—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:
) IYES 1<NO Does the site contain any Jurisdictional Wetlands'!
I_IYES I_I NO Do you plan to have an irrigation system now or in the future?
i—I YES 1. I NO Does or will the building contain any drabs!Please explain. _ -
IIYES II NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
)_IVES {_I NO Is any wastewater going to be generated on the site other than domestic sewage?
iIYES I—I NO Is the site subject to approval by any other Public Agency?
1IYES I—I NO Are there any Easements or Right of Ways on this property'?
I—IYES II 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 Thal 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 Site Acce So at at A11
�Site Evaluation Can Be Performed. I I I I 'I
PROPERTY OWN OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/IO
NORTH CAROLINA 11COUNTY
CONTRACT
�TTO PURCHASE
his contra made e�nnd ente d into this day of ✓• ? by and between
pared_ ✓/./�rfa 'LC as SELLER,and l 4 r� We as BUYER.
WITNESSETH
THAT SELLER hereby contracts to sell and convey to BUYER,and BUYER hereby contracts to purchase from
SELLER,the following described residential building lot/s, to wit: ���
Being all of LOT/S 2d t
of Subdivision known as ^t (2 to
A map of which is duly recorded in Book of Plats Map.71;:y . Page 4I County Registry.
dir
Price is S 6-10:24°C
payable as follows:
Due Diligence made payable and delivered to Seller S
Initial Earnest Money deposit(To be held by Lynn Matthews Law Group) S
Balance due at closing S
1. The LOT/S shall be conveyed by SELLER to buyer by a General Warranty Deed free of all encumbrances
other than taxes for the current year; which shall be prorated as of closing.The Deed shall be subject to
all Restrictive Covenants, Utility Easements and applicable zoning ordinances on record at the time of
closing.
2. Buyer acknowledges inspecting the property and that no representations or inducements have
been made by the SELLER, other than those set forth herein,and that the Contract contains the entire
agreement between the parties.
3. C si Fina Settle t) is to take place no later than at the offices of
�/ Should BUYER fail to close, the S LLE , at his option, may retain sum
paid as a Down Payment upon the Purchase Price as Liquidated damages and declare this Contract null
and void and may proceed to resell the LOT/S to a subsequent Buyer.
3. (a) Cumberland Homes has agreed to pay all of the sellers closing costs in regards to the settlement
of this property.
4. Due Diligence: Made payable and delivered to Seller by the Effective Date of the contract. Due Diligence
period beginning on the effective date and extending through 5',OOpm on lime being
of the essence with regard to said date.
IN WITNESS WHEREOF the parties have executed this contract this day of
SE ER BUYER
4 ,
09/09/11 Application#
Harnett County Central Permitting
Each section below to be filled out PO Box 85 Langton NC 27548
B10 893 7525 Fax 910 893 2793 www Maned erg/permits
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Buddina and Trades Permit
name 8 phone must match
i
Owners Name , ./ ,/ ac-Au C • Date / /
Site Address fi //. to A - Phone 1 .0- :fi - 4V565
Directions 11 ob site from LII Ingtggn�if/k4 � /O copWA% Zit '• rL—
niR
Subdivision Zw,e-r✓e. Lot RC'
Description of Proposed Work of 5 F #of Bedrooms 3
Heated SF23fi Unheated SF IIQ Z Finished Bonus Room9Crawl Space _Slab
Ao / General Contractor Informatioli'
e�itiR �r'i p , Ia • qv-fez-44314-
Building Contractors CompanyL
me Telephone
-P•c • I 721 /ion, f'`� ar33S
Mrns�Gf to ru
.460
Addresss
LicenseEmail Addr
) 4/Leg 3
#
1 t r. •10r s • ul -, of
Descr ption Work 4 'z :moi `'Sfi r7" Service Size {/ Amps T•Pole tes No
'I v,St6 -4 /aero We,' a ,/'-(4 -- - 3r
Electrical Contractor s Company Name Te epho e
5'G1/3 4rr 7)ts laoxr F �-e ^I/4
Address Emai Address
11007- GC
License#
Mechanical/HVAC Con rector Information
Descr tion f Work Noc✓ 5:te'jC0 FAA-.
6 A N r-A oflq- 3z9-(24,r(7
Mecharfical? �b)rs Comp name Telephone
3 A r• ^ Xi
A�r / /,2 y aisle? Email Address
License# (IL[l
plumbma Contractor Information
Description of Work A 6 #Baths 3
44,ver6 '1l / ,4,14,i e. 4. 401- sort a&
Plumbing Contractors Com an ams Telephone
30L6
Address 0275,Z Email Address
n23I60
License#
_ ,c,710Z- insulation Contractor •gmtatioB
-I�e7/��Q�tiiY .J'/�Z F�'!� LSc' "lC4" 2�IZ few
Insulation Contract Company Name 8 Address i7 �,��ArC Telephone
r.l_��c zlGoef
*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 stonina 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
EXPIRED�;PERMIT FEES-6 Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
a
is rrent fee sched e /
i4n1
Signature of Own Contractor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation NC GS 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
l"---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 -y,
Company or Name 4, .4/ Ar/ - �f��
Sign w/Title './JL .���... • tits, Date ieibfirl
Harnett County
102 EAST FRONT ST
P 0 BOX 65
LILLINGTON NC 27546
DATE: 11/07/17 RECEIPT #: 0000011225
TIME: 8 : 10 : 54 CASHIER: JBROCK
APPLICATION NBR: 17-50042707
LOCATION ADDR: 49 TROPHY RDG
REFERENCE: NEW TANK
ITEM DESCRIPTION PAID
SOIL EVAL/NEW SEPTIC TANK 750 . 00
TOTAL AMOUNT PAID: 750 . 00
PAYMENT TYPE: ESCROW