DOCUMENT Initial Application Date: \\\\s % 1 Application# t 1 Sc C] -4 3
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.hamett.org/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER: L5 % LL-L. Mailing Address: 1MA_ CAS A.„9,,.)
City: ''--rr ,, State: Zip: Contact No: 22 `` '' ,, Email:
APPLICANT": LA�L J 14( LGG Mailing Address: !1X)1 .J41Lgrbtircl.AU L LLO
city: illr. .1446loom State: A) Zip:Z?Z4 10 Contact No:Q t4 dlc SCw1 Email1i L1O �Z.p1 1 e� (
`Please fill out applicant information if different than landowner W�L.
CONTACT NAME APPLYING IN OFFICE: " 1 U.•r(JL.&I _ Phone# �{L ' `crGS"5(.!5 -17
PROPERTY LOCATION:Subdivision: okaocrucinfl
1�U(I LGICSQ� Lot#: (iD Lot Size:D.14,
State Road
# ` / 1� State Road Name: k\` L) 6ti.NC-5 �,/• /, 2 Map Book&Page' ZonI 3�. .
Parcel: 00,� 9116 n'7.S1S ` ' PIN:O.w--1 -$ 3 L�
Zoning �7 Piood Zone: N Watershed: V Deed Book&Page: 394.5 /Oft 6'7 Power Company`:
*New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
jit SFD:(Size 3t x 34 #Bedrooms:A#Baths Basement(w/wo bath): N Garage:�( Deck:A) Crawl Space:_Slab:_ _Slab: )(
(Is the bonus room finished?(_)yes (_)no w/a closet?(J yes (_)no(if yes add in with#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?(_)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:
❑ Addition/Accessory/Other:(Size x )Use: Closets in addition?(J yes (_)no
Water Supply: V 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 (1)no
Does the property contain any easements whether underground or overhead(1)yes ( )no
Structures(existing o ropose :Single family dwellings: l Manufactured Homes: Other(specify):
9
Required Residential Property Line Setbacks: Comments:
Front Minimum 35 Actual Z--2
Rear Z S .5
Closest Side \ 0 \
Sidestreet/corner lot 20
Nearest Building
on same lot
a ay •
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON.Vra, L. lin (4Wc. ?10 3 '
, 1 CL-+�-,�-_
L2,c- O4o 5. rn(i v - Tin4,0 Tv ro 2 o iN4-o e rrn14-5f-.
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 ements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
Cc.,rr�e ►p \�qn
Signature of Owner*
wner ner's Agent 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"
6 MICHAEL P. GRIFFIN , ow1I that undor my dfr.ctkn and
o pa►a/an thpr map was drama from an actual fkld*servo that the saw of
closure of the wavey os calculated by coordi otos hr 1: 161000*; that the
aroo shown honor, was calculated by coo dhotea BK
M?Mess my hard and sed thhr day of MONM 2017. h'gRNPAc°GF
RE%rik,
SITE PLAN APPROVAL &
DISTRICT
*BEDROOMS
1 W 65.97'
Dais N 7°30'59
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4,
CP CSI
1 PAD 25:' U,\•
N 15.00' rn
W Sp tri .
= 21 .00' e 9
61 60 \. : .
PROPOSED -. \
8 182613
SLAB 0
m cv
m \ \
8,990 SQ.PT. I `i\
0.21 AC. 1 I
— FFE 27I.6O - N •
•
— 12.0 20.00' 0 16.00' I Q I
n
,,$) c
PROP i
CONC
DRIVE .
-----\ 0
Z I
CO l •r-J
) I> 5207h1e . r
MALLOW OAK STREET
50' PUBLIC R/W
SETBACKS
FRONT 35'
REAR 25'
511)E MIN. 5'
SIDE AGG. 15'
REVISION: HOUSE CHANGED TO 1 826 8/9/17 LEGEND sI • 0000/ID
PRELIMINARY EIP EXISTING IRON PIPE FES FLARED END SECTION o
IPS IRON PIPE SET WM WATER METER lA.
NOT FOR RECORDATION, RW RIGHT OF WAY CO CLEAN OUT I t
SALES OR CONVEYANCE WF NOW OR FORMERLY FH FIRE HYDRANT
EI5 EXISTING IRON STAKE CB CATCH BASIN
114 GRIFFIN LAND STIR VEYING, INC PLO FO PLAN
R
iP. O. BOX 148
FUQUAY — VARINA , NC 27528 I'% .,J!-'I, LI_L_ cI .
m
�., (91 9) 587 - 1983
OLDE FARM VILLAGE
DRAWN BY KDF DATE 7/19/17 LOT 60
HALLOW OAK STREET
CHECKED BY MPG SCALE i" so 20' NORTH CAROLINA
HARNETT COUNTY ANDERSON CREEK TWSP.
09/09/11
Application#
Harnett County Central Permitting
Each section below to be filled out PO Box 85 Lillington NC 27546
by whomever performing work 910 893 7525 Fax 910 893 2793 www harnett org/permits
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name&phone must match
Owners Name 10l1Qd4.Jj,rh L 1.40114.16 t a-L.
Date
Site Address 151 l-\a kxA) O& �-. Phone g!r[-CIC4 c,
Directions to job site from Lillington 'I 6..v.,Q e..
6.1..1%614146-v. /1nt 0 4-urn Q . . g. r-febn#
Subdivision ott L -6,8.11Nel (1111 4.4, Lot (ID
Description of Proposed Work 57... #of Bedrooms Li
Heated SF 11521f Unheated SF lO(14 Finished Bonus Room
General Contractor Information Crawl Space Slab
(iu c IL- 33&Z 2.- a�
Building Contractors Company Name Telephone
3 6444463 round.Aut,64ez3o Cgrei161ooro Trzc.bi`!z.�u., Jorni homes.
Address +„�
' Z-)C..4 iQ Email Address COX/
License#
•
Electrical Contractor Information
Description of Work 411.4flea. 6 1 Service Size ZCO Amps T-Pole 1/Yes No
al ernci,vt L1t( -r l 33/4,-5 •clOQn
Electrical Contractors Company Name Telephone
I 11-67.p.j L TX..5 .LZOo Boob6 vi+Z-12.15
Address Email Address
ID511,
License#
Mechanical/HVAC Contractor Information
Description of Work W1Atilp9 1 Atr
e.rn ige�r•+Air
Mechanical Contractor s Company Name 336� G-730
Telephone
V D. 60t 5z`7 nit ihtf iii 2. 1 o 1L
Address Email Address
` 12155
License #
Plumbing Contractor Information
Description of Work P10114‘01 PIS -1(161.0 I #Baths
I' c 4- PI U YlRVj i vl 'MG. ?�3 u L• 75•t) Z.J
Plumbing Contractor s Company-Name Telephone
y63SIAd45L4,>, 00.
Address Email Address
Zip
oc
Insulation Contractor Information �
Insulation,SOIIS'' -1(15 a [ csii `f;14 •-)S{0'aS
s Company Name &Address 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 signing below I have obtained all subcontractors
permission to obtain these permits and if aany 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 cu ent fee ssclhe'd^Ig__
utIn
Signature of Owner/Contractor er(s)of Corporation Date 1
Affidavit for Worker's Compensation N C G S 87-14
The undersigned applicant being the
General Contractor Owner L./Officer/Agent of the Contractor or Owner
Do her by confirm under penalties of perjury that the person(s) firm(s)or corporation(s)performing the work
se
t fo 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 UJ&1 Liu rn ui t4Nev S
Sign w/TitleAdialgS Puna ii'C(Y Il'1a.. r Date tOI(4( r7
DO NOT REMOVE!
Details: Appointment of Lien Agent
Entry #: 748933 Filed on: 11/03/2017
Initially filed by: wjh2013
Designated Lien Agent Project Property
Print & Post
Investors Title Insurance Company OFV 60 ■''
157 Hallow Oak St. .rI+tiP
Online:www.liensnc.com.i, Spring Lake,NC 28390 kr
Address:19 W.Hargett St.,Suite 507/Raleigh,NC Harnett County O 14; .°
27601
Phone:888-690-7384 Contractors:
Please post this notice on the Job Site.
Faa:913-489-5231 Property Type
Suppliers and Subcontractors:
Email:su000naMiensno com „,..,,,,,,,,,,,,„„,r,,,,,,, Scan this image with your smart phone to
view this filing.You can then file a Notice
1-2 Family Dwelling to Lien Agent for this project.
Owner Information
WJH,LLC
3300 Battleground Ave Suite 230
Greensboro, NC 27410
United States
Email:trabitz@wadcjumeyhomes.com
Phone: 191-999-5565
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Technical Support Hotline:(888)690-7384