DOCUMENTS Initial Application Date- It tiSi I / MPI n# 1 `-^-"-' ' a / (.1+YJ
CU#
COUNTY OF HARNEFT RESIDENTIAL LAND USE APPLICATION
Cenbel Pemflkg 108 E.Front Street.LIINngton,NC 27548 Phone:(910)893-7525 ext2 Fax:(910)8932193 vww.hamell.org/permAa
'DA RECORDEDSURVEYRAP,,RECORDED
D DEE�D(OR
,OFFER TO PURCHASE)8 SITE PLAN ARE REE IRED(�NR/EAN,ISUBMITTING A LAND USE APPLICATION'
LANDOWNER. ,,�yi�t1T1n 1 TNMIQIe Greece III mailing Address: IW Li C1'`L✓y� • ^�/1
city: Li III n31-an J state:NCcmt91(OCantad Nn:95I-53t-4L % Email:re/Wilt/On/1�@yghW.C(f , ,
APPLICANT': J Mailing Address:
Cay: State:_Zip:-Contact No: Etna.
'Pea®fill out'teacart information A different than
'k/n_downeerr ^ Hallo,n
CONTACT NAME APPLYING N OFFICE: iCUITIIn HULIIII 1 Phone#6151-S�33-40S a
PROPERTY LOCATION:SubdMslon: Q 1 b V\.%er. 1�a/•/-eSLLot#: 1 I Lot Size; FI"
Stale Road# s b LS
State Road Name: ..Jl L✓J9_r Map Book 8 Page:aOO 7/ Lab I
Parcel:,a881/2� yO� S15 DlIcI ac. PIN: DSS`( 1A - �C9—ni - Qc9a•cop
Zoning:l'An3b Flood Zone: X Walamhed:p_A__l_Deed Book 8 Page?4O0/9�'Powo Company':
'New shoelaces with Progress Energy as service provider need to supply premise number from Progress Energy.
PRQPOSED USE:
Monolithic
it SFD:(Size, _ft =#Bedrooms:_#Baths:_Basement(wMo bath):_Garage_Deck:_Crawl Space:_Slab:_Slab:_
(Is the bonus room finished?( lyes ( )no ad closet?L.jyes I 1 no(if yes add In with#bedrooms)
❑
Mod(Size )#Bedrooms_#Baths_BaseneM(wlwo bath)_Gauge:_SAe BUR Deck:_ On Frame_Off Frame_
(Is the second floor finished?( )yes ( )no My other site buil additions?(J yes Li no
❑ Manufactured Home: SW_DW TW(Size x )#Bedrooms:_Garage: tete built? I Deck: (site built? )
❑ Duplex:(Size_xJ No.%idings: No.Bedrooms Per Unit:
❑ None Occupation:#Reams: r� Use: Hours of Operation: #Employees:_
AddtioiAnwssory/Other (S¢ex_40 Use: u A� I _\ lit
7 Closets in addition?(J yea Li no
Water Supply: V County _Existing Well _New Well(#of dwellings using well_)"lust have operable water before final
Sewage Supply:_New Septic Tank(Complete Cheddist) / Existing Septic Tank(Complete Deck/ht) County Sewer
Does owner of this had of land.own lard that contains a manufactured horns with five hundred feet(500•)of tract listed above?Li yes 1±)no
Does the property contain any easements wteeo underground or overhead LJyes (Z no
Structures(existing or proposed):Single family dwellings: ktj( Manufactured tomes: Other(apoiyl: p[
Mitt
Required Residentirall Property� ` Line Setbacks: Comments:
Front Minimum2&MrtActual 1 ,L� -
Rear [ �C Cars Imp ca V u�'
Closest Shoe laff S "rl'Ttvs'. *kr. ref-)Ka'ak`/
Sideefreegcvoner lotNearest Building I05{t
on sane lot
'.cnua,Lana Use AnrncalIon Fane n
APPUCATION CONTINUES ON BACK
SPECIFIC DREC11ONS TO THE PROPERTY FROM LILLINGTDN.
V g1 . r I cPl 4 -1 lint
Onto mcoo1aldRd�—Cthvn g�gqnt into •e rock. • Tuve UPI- on
LaAtho.v LYI 1 4-IcL&e (Yl Ietr- hand Silt.
If permits are granted I agree to conform to all ordinances and laws of the Stale of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that forego) stab :nm ai • rate correct to the of Imowl.•.0. Permit subject to revocation if false information is provided.
Signature • , or Ow arE%7 �•
ash Is the owner/applicants rxponalbillty to provide the county with any apPlloable Information about the subject property.including but not limited
to:boundary Information house location,underground or overhead easements,etc.The county or Its employees an not responsible for any
Incorrect or missing information that is contained within these applications.''
•Thls application expires S months from the Initial data N pants have not been Issuer
R sidel alai Land seAcnl¢a : k:.;. _ •
_ t711
10i
6u)pltne psodard
I
a
Cca
a
z r•
CL o o
w 2
i5n1—
CI x01
pus
—11) (;\
19Q II I
a
I �
.5601
I ' '
I l I
' I
~ I
I ti
9
tirc ( II
-/-22d 0/ = W21 L
t£¢Z
NAMETajIovt f°atthneV4tf'f t APPLICATION*:
*Phis application to be tiled oat when applying fora septic system inspection.*
County Health Denartment Aunlication 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#
0 Enwronfrwnta/HN/m Naw Stack SvstalCode 800
• MI Droned,/ Irons must be made visible. Place 'pink property flags' on Bath 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 atdor 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 undxarowth to allow the soil
evaluation to be performed. Inspectors should be able to walk freely around she. Do not grads property.
• ...LLL! .Ili I a: _ : tr. . i t an er rr r r Lll. u - uc d dr.:
for tenure to uncover outlet lid mark house comers and wooerty dose etc.once lot con limped toady
• 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 t roof of request.
n • Use Click2Gov or IVR to verify results. Once approved,proceed to Central Permitting for permits.
l ggvaonm•fdal Smith Existing Tank Maosotlons 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 lilt 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 and 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 aoof of request.
• Use Click2Gov or IVR to hear results.Once approved, proceed to Central Permitting for remaining permits.
SEPTIC
If applying for authorization to consmrct please indicate desired system type(s): can be ranked in order of preference,must choose one.
1 Accepted {_l Innovative f onventional 1—I Any
1 Alternative I Other
- applicant shall r. the ocal health depattme. upon .ubmittal of this application if any of„ Rowing apply to the property in
• stion. If the i.,er is'ye-",applicant MUST ATTA I' SUPPORTING DOCUMENTA . ON
1 LYES 1 NO Does the site conte any Jurisdi i oral Wetlands?
I )YES ./�I NO Do 'ou plan to hay an'ri•_ .�� now or in the future?
{ }YES Y�I NO Doe;or wig the • ding contai any drains?Please explain.
I -.}YES 1_y[/'NO Are here any e sting wells,spri gs waterlines or Wastew: er Systems o this property?
I )YES L NO Is anywastew: -r going to bege, rated on the site other • • domestic se age?
I IY ` { //INO Is • -sitesubj • to approval by . .y other Public Age • ?
1 l . I.IC��I NO Are ' •re any merits or Right •f Ways onddsp • -. ?
1 ) :• 1hLl NO Does ••- site ontain any existing :'-r,cable,pho or underground elec• lines?
If yes .1 . •call No Cuts at 800-63- '949 to loc. - the lines. This is afre •-rvice.
I : y Read wiz Application And , . 'That The Information Pr. .ded : - • Is True,Complete And Co wt. . uawrized County And
Sete Officiate Are Granted Right • ry 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 An Property Lbws And Corners And Making
The legOA, Site Evaltgtlm Re Performed.
ll I 15I R-
P ERTY OWNERS OR OI�_ GAL ATIVE SIGNATURE(REQUIRED) DATE
10/10
HARNETT COUNTY CASH RECEIPTS
aaa CUSTOMERRECCP EIaaraaer: 1
Opel: JBROCK Type:
Date: 11/15/1? 52 Receipt no: 154825
Year Number Amount
2817 58842766
91749 TECH 2
B4LLINGTOH, BP 2?546
ENV HEALTH FEES
B4 4188.80
EXT TANK
KAITLIN GUERTIN
tender detail f108.8B
CP CREDIT CARD 4188.88
Total tendered 5180.08
Total payment
Trans date: 11/15/17 Time: 13:44:17
as THANK YOU FOR YOUR PAYMENT as
Application# L-19---7 LQ Cp
Hamed County Central Permitting
'Each section below tobe toed out PO Box 65 Lillington,NC 21516
9188931525 Fax 910-893-2793 wwnt hametteigipemlM
by whomever performing work.
Must be Amer or licensed
contractor. Address,company Application for Residential Building and Trades Permit
name&phone mist match
Owners Name: TA�` Id✓ i-l-'gltll✓1 6Nfrt1✓1 Date: IZIll3-
Site Address: 150 7x.tc leu.' Ln . Li I I l n cion , N n 235Ylfhone: l-5 ' IbSU
Directions to job site from Lillington: ✓J
C'jo StrniytOflto USLIal / Tuvn tsf+t on manel/4lad ,Turn rlr•ht
cm -to Mc( OSfiyry) 4a� 1Tuvn Lifte-l(I[finteal, ufton AdCOCKOclri lltm
Subdivision: Lot: -{clll,rLn
Description of Proposed Work: #of Bedrooms:
Heated SF: Unheated SF: Finished Bonus Room? Crawl Space:_Slab:
General Contractor Information
5Stnr Pit dding5 ,3310 - +5(o- Z2.20
Building Contractors Company ame Telephone
Address Email Address
Ufate-
License# .39/000
Electrical Contractor Information
Description of Work Service Size: Amps T-Pole:_Yes_No
Electrical Contractors Company Name Telephone
Address Email Address
License#
Mechanical/HVAC Contractor Information
Description of Work
Mechanical Contractor's Company Name Telephone
Address Email Address
License#
Plumbing Contractor Information
Description of Work #Baths
Plumbing Contractor's Company Name Telephone
Address Email Address
License#
!Emulation Contractor Information
Insulation Contractors Company Name&Address Telephone
`NOTE:General Contractor/owner 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 slanina below I have obtained all subcontractors
permission to obtain these permits and if gm 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 as per current fee schedule.
el-1-1C) Etas to �ao/
Sig re of Owner/Con dor/ c s)of Corporation Date
Affidavit for Worker's Compensation N.C.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
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.
Company or Name:
Sign w/TUIe: i G Date:
�d ��