DOCUMENTS Initial Application Date:'Sp S/ 10 Application# t Q sot L{ 31o10s
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.hametl.org/permits
"A RECORDED SURVEY MAP,P,RECORDEDRE�� RDEDDEEDEEOR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHENSUBMITTINGA LAND USEAPPLICATION"
LANDOWNER:.` 0511 }\/^L.-ll '1 '/ Mailing Address:LIS COKES �/I��(s�k�',I}-�}���� �('lly��Y
City: '3 ,�LZnStafk:"- Z'I� ntact No: Email: J r Dt/ /T t tr~„ .C
APPLICANT': SC0 I \ CD ailing Address: /
COM
City: State: Zip: Contact No: Email:
'Please fill out applicant informaban if different than landowner
CONTACT NAME APPLYING IN OFFICE:
'�K I f�/�/'N �/1 Phone#
PROPERTY LOCATION:Subdivision\ 1-11`€9/0/ ``zl PDX-` I L I ,. Lot#: LP Lot Size: 1 33
State Road# I 1 S State Road Name: W bsX 4.L Leal-,
cu-L t�iZw1 sisigo B000k�&PPa�g�e:9oa /4 3y
Parcel:
� �1b�,S, v� 3s (Mace /3 PIN: T pip 35 '� 1 - "'g1I .x)b
Zoning:�Jao_Flood Zone: k Watershed:M4 Deed Book&Page:) Q 37/ Lo Is 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: Slab:_Slab:_
(Is the bonus room finished?(_)yes (_)no w/a closet?( )yes ( )no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms_#Baths_Basement(w/wo bath)_Garage'._Site Built Deck:_ On Frame_OH 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:_
B� AtltldionlAae
✓
Addition/Accessory/Other:(Sial'_) x(S' Ise: —Li r Y 1 Closets in addition?( )yes (_)no
WatererSupply: 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 ( o
Does the property contain any easements whether underground or overhead(_)yes ( )no
Structures(existing or proposed):Single family dwellings:
J\\\\lManufactured Homes: Other(specify):tther((sppeciify):
Required Residential Prone Line Setbacks: Comments: V V ) V'\l51I CV lll /
i
Front Minimum Actual Y�NI / S � C I
Rear
Closest Side
Sidestreetcorner lot
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: V"`-" 1V,V VL
\ /
If permits are granted l agree to con'. to .I . an. -1 of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing statements rer.i ra - •nd:alto' •the best of my knowledge. Perini ubj o 'oq ifJglse information is provided.
•
Signatu , .f.:, ner or I nor's A, nt Date 1`(/�
•
."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.Thetounty 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 H permits have not been issued"
Residential Land Use Application Page 2 of 2 03/11
115 Cokesbury Park Ln to 108 E Front St, Lillington,NC 27546- Google Maps Page 1 of 2
Go gle Maps 115 Cokesbury Park Ln to 108 E Front St, Drive 15.3 miles, 21 min
Lillington, NC 27546
115 Cokesbury Park Ln
16
Take Cokesbury Rd to NC-42 E
1 mir.(05 mi)
t 1. Head east on Cokesbury Park Ln toward Cokesbury Rd
0.1 mi
h 2. Turn left onto Cokesbury Rd
04 mi
Take Christian Light Rd to McKinney Pkwy in Lillington
16 min(127 mi)
r 3. Turn right onto NC-42 E
0.3 ml
✓ 4. Turn right onto Oakridge Duncan Rd
21 mi
N 5. Turn right onto Christian Light Rd
77 mi
r 6. Turn right onto US-401 S
2.7 mi
✓ 7. Turn right onto McKinney Pkwy
2 mm(0.8 mi)
✓ 8. Turn right onto N Main St
2 min(1.2 mi)
9. Turn left onto E Front St
0 Desi naton will be on the right
54 s(0.1 mi)
108 E Front St
t::en Niv tr .,
These directions are for planning purposes only.You may find that construction
projects,traffic,weather,or other events may cause conditions to differ from the
map results,and you should plan your route accordingly.You must obey all signs or
notices regarding your route.
https://www.google.com/maps/dir/115+Cokesbury+park+Ln,+Fuquay+Varina,+NC+2752... 3/26/2018
09/09/11 Application#
Harnett County Central Permitting
PO Box 65 Lillington NC 27546
Each aecnan below to be filled out
910 893 7525 Fax 910 893 2793 www harnett orglpermits
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name&phone must match r h N �
Owners Name 3CD-T—T P� .� � )��� /"�/"�� '�`�//� Date(5121)I lb
Site Address l l 5 `uKL-✓rtllAy U t'CA" 4� L v/ LU Phone -I I L39p4-0031
Directions to lob a from Lllin ton
on ✓
/� r,`(tll1V10 ]''��/�
Subdivision l ) e5\ uti CP}nw1,,�II—' Von
Description of Proposed Work I v U v I LY,{S V y I #of Bedrooms
Heated SF Unheated SF FmisheC Bonus Room'? Crawl Space Slab
ix
v�l /prTc eneral Contractor Information It w___, �o3i / `�
B I V(/r r t. ac"JCom any
�e!p"/II r co
1 f) ((set, `-�'e/
Address Email Add s
License#
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 ry'
Mechanical Contractor s Company Name. q�S"(t�� 6Uephone
Address `_ � Email Address
License#
Plumbing Contractor Information
Description of Work t�-yv�#�aths
Plumbing Contractors Company Namely ' „� ,L!'r✓•v 7� �TTeelephone
Address y'"'� (�J- Email Address
License#
Insulation Contractor Information
Insulation Contractors 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 atanina below I have obtained all subcontractors
permission to obtain these permits and if a4II 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 !-s
EXPIRED - -MIT - -6 • s to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is as per curre ens .dule ej) \To \ On
Signature of Owned o\ .: . officer s)of Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The undersigned applicant being`the/
General Contractor V 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
/
V 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 Na • I / ,
Sign w/Title .Aar la 1,---/ s Y Date-27P401 J
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