SETUP/PERMIT/RECEIPT Application# 1�54.0 tli
Harnett County Central Permitting11.6
PO Box 65 Lillington,NC 27546 ermits
Telephone Number: 910-893-7525 Fax 910-893-2793 www.harnett.orglp
A cation for Manufactured Home Sec-Uo Permit
(Please till out each part completely)
Part I-Owner Information:
Home 01 II. er Information (To be completed by owner of the manufactured home) _ , /
Name:u l . �(��- P a . n Address: 9'.nn pv�
City: /1l,HUr State:AI. LZip: g 737oC Daytime Phone: 4rlt35 a - I nEL
Landowner Information (To be completed by landowner,if different than above) .D It('^^ l li I` t QnhS AddressI -.
Name: :
City:
_gag-tan--
n--
SNnGI2✓d State:N�—Zip:�3 . Daytime Phone: an
.._��
d
by
or Homeowner,if
Part II-Contractor Information (To be Name,addreletea pho entre at match information on license)
A. Set-Up Contractor Company Name: . A 0
Phone: Address:
City:
State: ZIP'
State Lic# Email:
B. Electrical Contractor Company Name:
Phone: Address:
City: __---
State: Zip:
State Lic#___ Email:
C. Mechanical Contractor Company Name: I.t
Address:
Phone: Zip:
City: �
State:
State Lic#____--Email:
D. Plumbing Contractor Company Name: I.L I.!
Phone: ___--
Address:
Clay: ___---
State: ZIP'
State Lic# Email:
Part ill Year:
JManufacturedpl HomeRhformation
Model Veac
6 Size: 'I Xja Complete& follow zoning criteria sheet
Lot Number:
Park Name:
purchaseand that the constructionhe contractor
or
I format certify that have the authpermissionr apply for this permit, that the applicationtheris correctlt, including the truction or
and the Harnett County Zoning
information and have obtained their to these permits on their behalf,
Ordinance will conform to the applicableincorrect
manufactured home set-up rn has begins,
Ordinance. I understand that if any item is incorrect or false information has been provided that this permit could be
revoked.
I r A4Date
.ignatur H of Home Owner or Agent
need proof of year on the
purchase July I,he a,a County Ta 0 o rfm� v ry provided before a Setup Permit wille be iooof ars
purchased from the tax office of the county that the home is moved from. If the home is from a dealer, we
Form 500 and if available,the serial number.
List of inspections and Egress requirements available upon request. Progress Energy customers must provide Premise Nu04 ter.
SETUP
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Application Number 17-50040969 Date 3/05/18
Property Address 125 CLEMONS LN
PARCEL NUMBER 09-9568- - -0053- - -
Application type description CP MANUFACTURED HOME RA20R/RA20M CRITERI
Subdivision Name
Property Zoning PENDING
Owner Contractor
MARTIN BEATHE (WILLIAMS) OWNER
P O BOX 808
BADAIBLING STATION
APO NEW YORK NY 90984
Applicant
BROWN MAURICE
112 THOMAS RD
SANFORD NC 27330
(910) 723-1336
--- Structure Information 000 000 14X70 3 BR NO DECKS/PORCHES
Flood Zone FLOOD ZONE X
Other struct info # BATHS 2
# BEDROOMS 2 . 00
MOBILE HOME YEAR 1986 . 00
PROPOSED USE SWMH
SEPTIC - EXISTING? EXISTING
WATER SUPPLY EXISTING WELL
Permit LAND USE PERMIT
Additional desc .
Phone Access Code 1232149
Issue Date . . . 3/05/18 Valuation . . . . 0
Expiration Date . 9/01/18
Permit MANFACTURED HOME PERMIT
Additional desc .
Phone Access Code 1232156
Issue Date . . . 3/05/18 Valuation . . . . 0
Expiration Date . 3/05/19
Special Notes and Comments
T/S : 03/21/2017 08 : 06 AM DJOHNSON --
24/27 THEN RIGHT ON BBQ CHURCH RD. THEN
LEFT ONTO OLIVIA RD RIGHT ON MURCHINSON
TOWN RD
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call: (910) 893-7525 Fax: (910) 893-2793
Page 2
Application Number 17-50040969 Date 3/05/18
Property Address 125 CLEMONS LN
PARCEL NUMBER . 09-9568- - -0053- - -
Application description . . CP MANUFACTURED HOME RA20R/RA20M CRITERI
Subdivision Name
Property Zoning PENDING
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
Permit type . . . MANFACTURED HOME PERMIT
10 501 T501 R*MOBILE HOME FOUND. / M. WALL / /
10 814 A814 ADDRESS CONFIRMATION / /
20 818 Z818 PZ*ZONING INSPECTION
30 507 T507 R*MANUFACTURED HOME FINAL / /
ernett 9hnn111 :a
151 E For faceet
1 i1iinptan,_HC 27"45
e';Fhnne: H _
74* STITEE yLtP **t
filer: TPROOF Type: CP
Pate: 3/45/18 52 5ece(At no: 273'211
3e9 ca. 53i6263
Merch ID A: 100E
Cross re`eR 'b]71,546
Card pp: taxxrsatrree,Lt'
Pard tyro: HARTER THEE
Path code' 'EHfC5A
Date; 1191(12
Faynent tnt35; . 75.89
CAkeHOL ER OoKNOUTEDEED RECEIPT LE 60003
H116,UR 9 CEO IN TOR n ii : OF THE
TOTAL H1400 HEREON A D A R LFE 75 DENIM
THE 02116A'!51IP SIT FORTH IR%THE CPU-
HUEDiiTREEi9EiHT 4114 K.ISSUER.
Siyi t r —.__ __
HARNETT F0111Ti FAST, RECEIPTS
n.x 6O5TOMEF HERETO ser
@pe :FROCK Type f' brewer:
5a1e 3, /1A 52 Receipt no: E73911
Year Nomi:er dement
2911 5e 409E9
125 CLEMON LN
SANFORD. NC 27330
Pi 6p - PEPiT FEES
U75.g
SW1N
ROSELYr: Of[f9
finder detail
CA i;RED11 [ R '5.54
lutal. tendered tiT_00
iota] payment 8115.Re
Trans date: 3/95„E Time 10:57:37
*4 THANJr. 10, PAYMLn` kb