DOCUMENTS Initial Application Date: 3I WI ` e+ Application# Isscu434r2a
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.orgfpermits
'A RECORDEDpp11SURVEY��UMAP,F/RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION^
LANrDDOWNER':C611d Price 1L?Dnn Ay(s lie',je$$Ica ailing Ars�d�dress4p.S� lef8dln int \\ Z�
City:TInuaIA/MINX State:la'. 2ip7"K2b Contact No�11Q 6217-133pEmailsl.CSM "kQ W/�n 1.a)n7
APPLICANT': Mailing Address: J
City: State: Zip: Contact No: Email:
'Please fill out applicant Information if different than landowner
CONTACT NAME APPLYING IN OFFICE: Phone v,�(
PROPERTY LOCATION:lSubdivision: /'^ �� Lot#: 73 Lot Size�{�I • I `x
State Road# '&Rl State Road lN/ame: CJ'a.r 614.../1..!—..—( ��^/I.F__v a- Map•fBook&Page:PC*17i7C.
Parcel:
jj��b/ss�o 5b7 bates[ 1 s PIN:Ci S Cf(0 -- O a— -maw, 001.1)
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Zoning( 'n lood Zone: ' Watershed:/L. Deed Book&Page7S00 7«; Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Size x )#Bedrooms: #Baths:_Basement(wlwo bath):_Garage:_Deck:_Crawl Space:_Slalr_Slab:_
(Is the bonus room finished?(_)yes (_)no wi a closet?( )yes (_)no(if yes add in with#bedrooms)
❑ Mod:(Size_x_)#Bedrooms #Baths Basement(wlwo bath)_Garage:_Site Built Deck:_ On Frame Off Frame
((IIs the second floor finished?(_)yes ( )no My other site built additions?(_)yes ( )no
Il Manufactured Home: /SW DW TW(Size I x R 6)#Bedrooms: 3 Garage: (site built? )Deck. (site built? )
❑ Duplex:(Size x )No.Buildings. No.Bedrooms Per(inn: Y
❑ Home Occupation:#Rooms. Use: Hours of Operation: #Employees.
❑ Addition/Accessory/Other:(Size_x )Use: Closets in addition?( )yes (_)no
Water Supply: `I County Existing Well New Well of wellings 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 hundr d feet(500')of tract listed above?( )yes (j/no
Does the property contain any easements whether underground or overhead(, )yes ( no
Structures(existing or proposed):Single family dwellings: Manufactured Homes: yyy��� I Other specify):
pr_ 14
Required Residential Pro erty Line Setbacks:{— Comments:
Front Minimum ,3l Actual l E 5ff�1
Rear 12 J LFIO,�t/1'�
Closest Side v HQ Ok
SltlestreeVcorner lot (
Nearest Building I r
on same lot
Residential Land Use Application Page 1 of 2 03(11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: tie( �JJQ si n n l' ford 51- lauxirciS S ly .
T • la o• o . Uo . Of ... . est. Or �c Ie • a I Oki
Tom If f+ oak eS P• 1100 ; ksrn r c�( tit ort Moolata%
Turk elf onto l-h4een (Ld�lr .) I vrn (Qftanj CheroY.ee l n
Trnri #Q staynn cheroYYe Ln 4u4 Cherjee t n I it_
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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 fore!fling statem:• .are a . rate correct to-lest of ) e•.•q. P it subject to revocation if false information is provided.
! tJ /" . I i 1. '( 1� cl/sem
Signature o Owner or I TTer's Agent ate J
•
"'It is theowner/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 fo"r any
incorrect or missing infgrniation 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
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NAME: yeSSifCl('�ttCA £(\Y Id PnceIC Maung?rice_ APPLICATION#:
*This application to 1w 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 aVfor 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 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 (atter 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 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 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.
S PTIC
If applying for authorization to const .et p ease indicate desired system type(sb can be ranked in order of preference,must choose one.
{4I Accepted ( I I ovat ye {_j Conventional {_j Any
14I Alternative II ether ' 11
Thcliapplicant shall notify the b cal heal department upon submi al of this .pplication if any of the following apply to he property in
quee ion. If the answer is"y ",applic nt MUST ATTACH 5 "PORTI G DOCUMENTATION:
{ II ES {_1 NO toes the sit contain any Jurisdict' nal Wetlan• 1
{ I ES { ) NO Do you pla to have an irri•atio s st m now o in the future?
{ I ES II NO Does or will the building nontt n any drains?PI-ase explain.
1I ES I—I N . Are there an existing wells, •prings,waterlines •r Wastewater Sys ms on this property?
II S I ) 0 Is any wastew ter going to ie generated on the si.' other than di estic sewage?
{_IY S I—i 0 Is the site subjecto appr al by any other Public At- c ?
(_IY:S I NO Are there any Easements or Right of Ways on this property?
f_IYE. { i 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 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 Re onsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site Accessible S�o/T�1t�st A C tete S' valuation r Perforr•��/ ,/
PR ERTY OWNERS OR OWNER LEG REPRESENTATIVE SIGNATURE(REQUIRED) DA E
10/10
Date: //�//C? Application,*
PROCEDURES AND GUIDELINES FOR MANUFACTURED HOME INSPECTIONS
RA-20R& RA- 20M Certification Criteria
nes m.{{trkP
lit ct ledilidttarneA understanid that because I'm located in a RA-20R dr RA-20M
Zoning District and wish to place a manufactured home in this district I must €following criteria,
verified by zoning inspection approval,before I will be issued a certificate of occupancy for this home.
1. The home must have a pitched roof, for a manufactured home, whether A-shaped or rounded,
which has a minimum rise (measured at the center of the home) of twelve (12) inches for every
seven (7) feet of total width of the home. (Example: A home measuring fourteen (14 ft.) in
width must have a twenty four(24) inch rise as measured from the center of the roofline to the
baseline of the roof.) (See Illustrations Below.)
24"Minimum R� v' A-Shaped 24"Minimum t Rounded
Roof Pitch Rise Roof Pitch Rica . r
•
C3 13 2098 -
Note: Most Rounded Roofs Will Not Meet The Roof Pitch
Requirement As Illustrated. The Measurement From The Peak Of
The Roof To The Base Line Of The Roof Must Be 12" For Every 7'Of
Total Width Of The Home. (Ex: 14' Wide Home=24" Roof Rise)
Continued
2. The home must be underpinned,consisting of a brick curtain wall or have galvanized metal
sheeting,ABS or PBC plastic color skirting with interlocking edges, installed around the
perimeter of the home. Skirting shall be consistent in appearance, in good condition,
continuous, permanent,and unpierced except for ventilation and access.
3. The homes moving apparatus must be removed, underpinned,or landscaped. (See examples
below.)
r e
i.,
4. The home must have been constructed after July 1' 1976.
Signature of Property Owner/Agent Date
• By signing this form the owner/agent is stating that they have read and understand the
information on this form.
Application#
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910-893-7525 Fax 910-893-2793 www.harnett.org/permits
AAgplication for Manufactured Home Set-Up Permit
(Please fill out each part completely)
Part I-Owner Information:
Home Owner Information (To be completed by owner of the manufactured home)
Name:RiCh'IYM%ie/ If'C5irla'Od Address:4' 5kie iI kl
•
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City:Ty :net ti rei_ State: /O _Zip: Zito Daytime Phone:(WI i1 i 0-8K SlO
Landowppn���e�r��Innforrmatioonn (To be completed by landowner, if Ldizfferre�nt than above)
NamettiarrCI Prirr 4-rtlrrinyfr&f limit,MYe'rAddre�ssst:Jl1 .*rd l 1 /�1/�. r �7 V
City: 1)Al[CO( State: ISG Zip:7 Q(C Daytime Phonegrt'lDI r� -O8SLD
�
Part II-Contractor Information(To be completed by Contractors or Homeowner,if applicable.
Name,address, &phone m t match information on license), �p
A. Set-pp/ iConttr1actlorrrCoompa'fy Name:80.ra CP4ttIf hat!) trnui g \(4
PhoyLrl 11fll'1��1�� S2-ll Address:334'S Wou'Q. Ini
City: ye.I :OAPP State: tOC. Zip: agSok
State Lic#02. 0 3 Email: ,. S
B. Electrical Contractor Company Name: C`r' tY Ie � A
Phone:41c17G1 -2.524 Address:
City:Wit bul<Nett State: NC _ Zip: awn_
State Licit 17 Q It Email: D 1 1(11v
C. Mec //n�iical Contractor Company/_ Name: 01 00 ",,rte uC�IA F\ , (Ince I i e 7!
Phon : Ill 1 o-�old Address: La Skid kl.
Ity M State: \ Zip: L
S£aTegILicccttralA AAIRSS1 Email: i • 4a I f. 14 �a�N►�
D. PlumliiRg �Jl�(t Contractor
Company Name: If�r—I 11�,s�1 �,1rrareareu
Address: NM J#
`fin : i e 44State: S. Zip: w r
•State Lic# '••(D8�p'j•• { Email: ' (' . ' t, I Iv . 1V
Part III-ManufacturedVl �77rr++� Home Infor atlon
Model Year:Wt e Size:14 x t) Complete& follow zoning criteria sheet
Park Name: Lot Number:
I hereby certify that I have the authority to apply for this permit, that the application is correct including the contractor
information and have obtained their permission to purchase these permits on their behalf,
and Harnett construction
Countystctioni or
installation will conform to the applicable manufactured home set-up requirements, and
ng
Ordinance. I understand that if any item is incorrect or false information has been provided that this permit could be
revoked. r
3/D5/Y8
r. .,.fir .
".nature of o i- Owner or Agent to
'Effective July 1,2004,a County Tax Department Moving Permit must be provided before a Set Up Permit will be issued. It is
purchased from the tax office of the county that the home is moved from. If the home is from a dealer, we need proof of year on the
Form 500 and if available, the serial number.
List of inspections and Egress requirements available upon request Progress Energy customers must provide Premise Number.
04/11
SETUP
HARNETT COUNTY CASH RECEIPTS
+mm CUSTOMER RECEIPT mma
Oper: JBROCK Type: CP Drawer: 1
Date: 3/06/16 52 Receipt no; 277020
Year Number Amount
2818 50043472
91749 TECH 2
LILLINGTON, NC 27546
B4 BP - ENV HEALTH FEES
EXT TANK $100.00
JESSICA MCLEOD
Tender detail
CA CASH PAYMENT $188.88
Total tendered $188.88
Total payment 4188.8@
Trans date: 3/86/18 Time: 18:49:30
** THANK YOU FOR YOUR PAYMENT **