DOCUMENTS Initial Application Date: I2, 08- I7 Application# 1 r7 SCeLl 4893
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COUNTY OF NARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108E Front Street.Lillington,NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.harnett.orglpermits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)8 SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER: SC.rrT reicr Mailing Address: Ili 181...4 Fk:arernr� St-
City: Fiteuf^y Uaa,nrs. State:f-C. ZipflfA.Contact No: 975-/(p9-(z+-vly Email:Scrrf04 -eavcle-n.
APPLICANT': A/CTSP& ,ji ' larLnr.baj Mailing Address: 'lr.. ANN.ek b_ -" t7d
City: F on.4 V°C:a State:pk Zip: 9153e Contact No: 'i lH-bla'i-ten/er) Email.An speuetly C'@h/r�IU j� J�...a' a. 1
•Please fin out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: IVi(X 'T,T Phone# I15- d.( 9, ]e:7
PROPERTY LOCATION:Subdivision: Lot#: — Lot Size)` int_
State Road# State Road Name. US 4 I N Map Book 8 Page: ( -TTS
Parcel: b8 b(DS'4 bb ,�PPIN 3473±Cbio 53 -1 �W33 - (-100f • 004
Zoning" Flood Zone. X WatershEtlr]G Deed Book 8 Page , Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
-/ o / i' Monolithic
LL! SFD:(Size Xwpx if-Y)#Bedrooms:#Baths Basement(wlwo bath): y Garage: Deck: (/Crawl Space: Slab': Slab:
(Is the bonus room finished?((Ayes ( )no w/a closet?( )yes (moo(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 Boor finished?( )yes ( )no My 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?(_)yes (_)no
Water Supply: /County _ _Existing Well New Well(#of dwellings using well )'Must have operable water before final
Sewage Supply: I 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(5001 of tract listed above?(_)yes (Z-)no
Does the property contain any easements whether underground or overhead( )yes
Structures(existing or proposed):Single family dwellings: Mapufactured Homes: Other(seedy):
p'roP0
Required Residential Property Line Setbacks: Comments:
Front Minimum 3�1 C Actual /or
Rear .fS / Sy
Closest Side /b �C
SidestreeVcorner lot
Nearest Building N N ///P
on same lot
Residential Land Use Application Page 1 of 2 03111
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: -/Gro 124 omit. S M,a:, Str e ,% %)/ . 6u
got N. th+rc tar+, (04.,;,„ Cn ya/ u co- ri - s,,. J st 8e4-e,
L6y {e+1G 7a , Trn GCI- on +Oti. y ,z. S+ fn vs -Tai la.
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 statem s are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
Iol/D3///
Signature of Owner or Owner's Agent Date
'"It is the ownerlapplicants responsibllit'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
NAME:Aki silt,- <I41 (ey4,v.1i j L,t APPLICATION4:
*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)
910-893-7525 option 1 CONFIRMATION rl
Environmental Health New Septic SvstemCode 800
• All property Irons must be made visible. Place "pink properly 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 aVfor Central Permitting.
• Place orange Environmental Health card in location that is easily viewed from road to assist in locating properly.
• 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 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 fur authorization to construct please indicate desired system type(s): can be ranked in order of preference,must choose one.
f—I Accepted Il Innovative
IL+1 Conventional ( )Any
( I Alternative f_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:
1_}YES IlzINO Does the site contain any Jurisdictional Wetlands?
LIYES 1J/NO Do you plan to have an irrii6aikonam now or in the future?
{_IYES IY` �rNO Does or will the building contain any drains?Please explain.
1 It
}YES Z1 No Are there any existing wells,springs, waterlines or Wastewater Systems on this property?
I—IYES 1(2'NO Is any wastewater going to be generated on the site other than domestic sewage?
IYES LIZ—NO Is the site subject to approval by any other Public Agency?
f_IYES 1I NO Are there any Easements or Right of Ways on this property?
I_jYES 1-1�0 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 Understand That I Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site ces ble So That A Complete Site Evaluati n Can Be Performed.Tor
P OPERTY OWNERS OR OWNERS LEGAL REPR SE ATIVNT E SIGNATURE(REQUIRED) /DA ih•r,
10/10
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1158.18,1CAROLINA GENERAL WARRANTY DEED
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Excise Tax: $270.00 / /„,...-----,.,
Parcel Identifier No. 080654bB8ge�Gedby County on the day of 20
Mail/Box to:GRANTEE \ \ /�
This instrument was prepared by: _, s ,w1foie.,u . ,:,n' .• -
1 N'N.)
Brief description for the Index: .. i , :�w . , %�
THIS DEED made this 14� day of January,fir. anfrl&etwecn
GRANTOR \\ GRANTEE
Earl Eugene Gray,Jr.and wife,Tamf .1Sc tty Tart and wife,
Marie Tlmperio;Brenda Lucille Gny /Kfistle D.Tart
Talton and husband,Thomas Dudley .-
Talton;and Betty Jean Gray Kiefer \ / lit\W.Academy Street
and husband,Brent Steven Kiefer Fug y-Varina,NC 27526
432 Kipling Road ,�}
Fuquay-Varina,NC 27526 1_0)
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Enter in appropriate block for each Grantor and Grantee: name,mailing addfeaseo�Jraprpe\Hate,character of entity,e.g.
corporation or partnership.
The designation Grantor and Grantee as used herein shall include said parties,the heier-s�ca.sent,
and assigns,and shall include
singular,plural,masculine,feminine or neuter as required by context. S„//. 1
WITNESSETH,that the Grantor,for a valuable consideration paid by the Grantee,the gd1 t9f h i ereby acknowledged,has
and by these presents does grant,bargain,sell and convey unto the Grantee in fee simple,a1 at4€r cin ofparcel of land situated
in Hector's Creek Township Harnett County,North Carolina and more particularly describaeesiot1yA:
SEE ATTACHED EXHIBIT"A" C.( \f
If checked,this property Is the principal residence of the Grantor. G " )'t-^,
NC au Associaian Form No.J®19)6,Revised®1/IRele .16.,"l// -w„/
Miasma's by Aarwmewith the NC Bu Asrocitcm Ca,,
B3477 - P307
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nyll&pinabove described was acquired by Grantor by instrument recorded in Estate File 14 E 548;also see 10 E 28,Book
X1'6( ,Peg*454 6 Book 695,Page 900.
\ Grant's Earl Rupee Gray,Jr.,Brenda Lucille Gray Talton and Betty Jean Gray Klefer are the Hein of Earl
'-Rugs e�3fily ead Jean N.Gray.
TOS,
.1D 7bHHOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee
in fee pl
Andltis 9n is with the Grantee,that Grantor Is seized of the premises in fee simple,has the right to convey
the end In t a t tmarketable Ianf free and clearnwhom se,encumbrances,mid Grantor i g exceptions:ns:
defend e t a t thea 1 claims of all persons whomsoever, other than the following exapllatu:
This conveyor a s milds sub I to the lien created by all the Grantors'real 2017 Hamad County ad valorem
taxes on said I // a ch \�s)agree to assume and pay in Poll when due.
Subject to all easemgole,4gh^f wN' c,covenents and other restrictions as shown on the public record or as would be
disclosed by an accedes ?mit tion of the land.
REMAINDIKOFflGE1NTEE\NTIONALLY LEFT BLANK
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M P7EGF,the Grantor has duly executed the foregoing as of the day and year first above written
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C�� . MY Comm.Ery1N67 , KI 'Ur,,.Moe• �///i�4�J-i�r/L'Cr d •e
N Tam'Marie Tim.-.o V
TBrenda Lucille Gray Tilt
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\/i —�V \ Brent Steven Kiefer
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83477 - P309
/ uof�W-Counttyor City of `',._',�
y I, mMent data Public of the Countyor Cityofy�(♦ and State aforesaid,coolly that fed Eugene Gray
U annVd(for I Marie Tlmocrio personally appeared before me t is day and acknowledged thedue execution of the foregoing
L-Instfryosee therein expressed. Witness my hand and Notarial stamp or seal this day offanuary,2017.
M Comfit' , Flus 5• n(1-7 I Notary Public
(AffixSmile,/ Notary's Printed or Typed Name
1 IF. MI"a.OWN
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1,the undersigned County or City of It>n ro and State aforesaid,certify that$rends Lucille
• i Si,.o t.;If- pe ally appeared before me this day and acknowledged the due execution of
the foregoing instrument for the •:... I n exdans2d. Witness my hand and Notarial stamp or seal this s s day ofianaary,
2017 i /tJv F%bfsd
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My Commission Expires: ,\ ,#AR yBp µn119 . ••Ui Ire _ ,Notary Public
(Affix Seal) z NY {1 ? Notary's Printed or Typed Name
Mranm`e,,
Stara of NC, •County or City of
I.the undersigned Notary Public of the County or CM - q, e and State aforesaid,certify that Betty lean Gray
K'alay and husband. Brent Steven Kiefer personally appeared bef• - rib); . , and acknowledged the due lion of the
foregoing instrument for the purposes therein expressed. Witness y hind and •lariat stamp or seal this rJ dry ,faamary,
2017.
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My Commission Expires; Cy 2:A1S psN "ITS ,. Is ili.�t ir4Aii �i1/ Notary Public
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BBIN - •£ - -nein tract of property known as.the David P.
Milton - o• t Loc eeeeeeii4qqi� in or near the Couemunity of Kipling, Hector's
Creek • hip Ha }County, N.C., and being bounded, now or
formerly, ee fo 'NXotth by the lands of Terry Johnson, and B.
Hall, Nes b hhyzug f Cooper's Branch, South by the:3ands of B. P.
Kendall, antEnt by the rights of way of U.8. Nighwayi401, and the
Norfolk and 86utp6;tr i 4way, and being more particularly described as
follows, \7
BEGINNING at a ppp�i1 t e c�atter line of U.B. Highway 401, said
point being locate ;a eprees 25 minutes West 75 feet from the
northeastern mos co er- f Hieb Terry Johnson property, running thence
South 65 degrees w1�afes. st 117.8 feet to a point in the 100 foot
right of way of the ,Nor elk 4iiiSouth Railroad; thence South 36
degrees 0 minutes WeltU9��LBm�Mt o a9pp000iint tin the Railroad right of
way; thence South
36 234 feet to a point ln
P. Kendall 6foot gNorth65ht of ydeerees 0 AtenWewst2020efest to ahpoint; thene along te linain tofBe
Cooper's Branch; thence i`gk,e/ "easterly direction with the run of
N„,/ %\
Cooper's Branch to an existing iron pipe'in said branch/ thence with
the line of E. Hall South 65 deg OO mLpoLps et 2069.4 feet to an
existing iron pipe; thence South 7 -degr'ees nut's Bast 388.51 feet
to an iron pipe, a corner with thb To ry ne n property; thence
along the western property line of . Joh on south 27 degrees 25
minutes East 174.5 feet to an iron pet •• long the southern
property line of Terry Johnson South see minutes East 345.0
feet to a point in the center line of U. ,Hfghw y 401; thence with
the center line of said highway North 2 dggrces S minutes East 125.0
feet to the point and place, of BSGINNIE
THERE IS EXCEPTED PROM THE ABOVE DESCRIBED PR T POLLONINGI
suns a tract of land containing 6.275 acres to 33A acres road
right-of-way, 6.158 acres net, known as Klpli Tri lief Pk, as shown
on map recorded at Plat Cabinet ID, Slide 81C, at 6 Htn4t County
Registry, surveyed and mapped by Stanoil and Asso at /m , Re .tared
Land Surveyor, P.A.,'dated January 9, 1989. A}
BEING all that parcel of land containing 2.344 acre& and one s, as
shown on map recorded in Plat Cabinet ID, Slide 145C; of tbe-yar ett
County Registry. <` /./e)
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Print this page
Harnett Legal DescriptIon:
COUNTY Harnett County GIS
1442ACS.1 T BARBOUR
PIM X540006 Tu Data Wt Modified:
PIN:R53-33-400800, Calculated Laid Units l Type:AC Ac
REID:0012469 Neighborhood:C0801
Subdivision: ACWN Year Bu01:
Doodad Acreage:0 c TotelAculaAnaHeebd:SqfFI
ToWAuepe:15.0355741 c SIM Month and Year 2/201]
Account Number:1500322257 Sale Pike:$135000
Owners:TART SCOTTY&TART KRISTIE D Deed Book a Page:34]]41306
Deed Oat.:
Owner Address:116 W ACADEMY ST FUOUAY VARINA NC 27525 Plat Book 6 Page:-
Ms/peewit Tyq:WD
Property Address:US 401 N FUQUAV-VARINA,NC 27526 Vacant or Improved:
City,State.Zip:FUOUAY-VARINA NC.27526 QuSllk ole:Q
Bulaing Count:0 Transfer or Spilt:T
Township Cob:M
Fin Cede:
Parcel Building Value:30 Pda Building Value:SO
Paul OUWUWMg Value:50 Prior Outbuilding Value:30
Pares Land Value:374230 Prior Land Value:$65930
Pace)S9Dc041 Lath Vale,'40 Prior Spacial Laid Valu:30
Total Value:374230
Parcel Osfvrtl Valu:$0 Mw Deferred Valu:30
Total Assessed Value $74230 Ria Assessed Value $65930
legal Land Unita,Unll Type:1442,AC Pilor Land UaIN:Sc
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09109/11 Application It
Harnett County Central Permitting
Each 110000 below to be Sled out PO Box 85 Winton NC 27548
by whomever performing work 910 893 7626 Fan 910 893 2793 www hamon arprpermN
Must be owner or licensed
contractor Add1ns 0pcnany Application for Residential Buildups and Trades Permit
name a phone must match
Owners Name ST 0,1-1- /42T Date /02/ f// 7
Site Address Phone 9/9-669_6,,6
Directions to job site from L9lmgton �rrt�a �7n J7u� Com-. /it' on y„/ S. Co /l44 .t
n, ,GV, JJf} Petri lark Dt a, /F F -774,-, [CI- ox 246.4„] .Lea I
ra,,J.;As. fo t/.t Gd of , s. it en LribeL./ n- I
Subdivision Ya Lot N,
Description of Proposed Work Pew Co,:l #of Bedrooms
Heated SF 32.1 Unheated SF/7/5 Finished Bonus Room9 V5' Crawl Space ✓ Slab
General Contractor Information
6Pec, a l�y tun 4f 11:n L 9/9- G 4,9-6.2,)
Building Contractor s Company Nand Telephone
7[h .via/Ir -tick ad 7 411 cy 4/ 444.kit. a 9S2. /lchSOee. tier .Lash fy(er f,•rde,_Ca i
Address Email Address
7,1,%/4-
License#
glectnal Contractor Information
Description of Work Gl.^e w..r Lion i t.xr/:r, 14. z- Service Size Amps T-Pole 'Yes_No
biker So , r 4IT<.ir;r 9/9-SS? - ,aura
Electrical Contractors Company Name Telephone
11( e UA+Ct fl' .. u:jQ 7)- Iv Pc 017,SJ 1. nn,,;c filats4SceSe le orris,
Address Email Address
,594$-L
License#
Mechanical/HVAC Contractor Information
Description of Work New Co+sv.(},en
QFrte ter;c4 579-S57-3Y,1y
Mechanical Contractors Company Name Telephone
J,) p1;(t'u^ On. r . Lit a7Jd6 ba,.ol/44&Cantlicvat..t,,,r
Address Email Address
-tk /SYbe
License#
plumbing Contractor Information
Description of Work l/cu/ Con.rl #Bathe y !/
S L'r-r jfrlM rMq-i P/x.n�A nips -jqs{
Plumbing Contractor s Company Nine Telephone
-)Yae .Se,../v! 2I w.s. Nc c)755a le.M.w ea_a_.M______.evl
Address Email Address
-ht 105/Y
License#
Insulation Contractor Information
-. C..)YJ c /a f> (7410v 3co4v Lis Ahl4 Arczw7 9/9-79= -9a Ay
Insulation Contractors Company Name&Address Telephone
'NOTE General Contractor must fill out and sign the second pegs of this application
I hereby certify that I have the authonty to make necessary application that the application is correct
and that-the construction will conform to the regulations in the Building Electncal 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 mama below I have obtained all subcontractors
permission to obtain these Dermas and if Amy 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 E150 00 After 2 years re-issue fee
is as per current fee schedule
ignature of Owner/Contractor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation NC G S 87-14
The undersigned applicant being the
f General Contractor Owner Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of penury 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 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 .1/c7 ,$ <(( 4/fr e;_4.-c /j /or
Sign w/T�dec� —C- Date )Jia A//7
DO NOT REMOVE!
Details: Appointment of Lien Agent
Filed en: 12/10/2011
Entry IFI 767069 Initially flied by: nctspecialty
Designated Lien Agent Project Property Print & Post
Fidelity Notional Title Company.LLC Hwy 40I Fuqury Varna NC 27526
aue<:axx Limo cam Harriett
Verne,NC 27526 YY
Nanlett Co:mty
Uttar N W Hargett Si_Sou 501:PAwgp NC 1:1 ,<
21611
Canneloni:
mmn.555e90.71w Properly Type Plum post this.notice on the lob Site.
Sac 913-489-5231
Enol:ypgpSyypnppwm m Suppliers nd$wMoetractor
&uanSethis image with your smart phone to
1-2 Family Dwelling view this Sling You can then file a Notice
to Lien Agent for this project.
Owner Information Date of First Furnishing
Scott Tan
116 West Academy Street 01/1512015
Fuquey Varna, NC 27526
United Stales
Email Seett@foreterdean conn
Phone 919f0-6006
View Comments(U}
Technical Support Rollin:(n5)69(47187