DOCUMENTS Initial Application Date: 41011Y
Appfication# I FS-co -34
CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPUCATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.hamett.org/pemrits
"A RECORDED
/SURVEY
IMAP,RECORDED DEED(OR OFFER-{ TSO,/p�URCHASE)&SITE PLAN ARE REQUIRED WWHEN SUBMITTINGUB� A LAND USE APP ICARON"
LANDOWNER: Ail v I L /Act 61 A,�,,Olej��/�19C(llr Mailing Address: p/''0`V Are, A g ^-
City: ' • , •_ • State:jtt' -zip,a3e6..�Contact No: C9��/t�z'7WI Email: �(X/t� L.Q4c (7 C D.'1iy
APPLICANT': <&,t'tt' As /Moue- Mailing Address:
City: State: Zip: Contact No: Email:
'Please fin out applicant information it different than landownerro1/,f, ,, /J �/J��// ^J //(�' //�\y�� p
CONTACT NAME APPLYING IN OFFICE: ,AA rC-'""e/( /Vi¢['.a/I^-a• Phone# --F-�W ( �� O�`/l
PROPERTY LOCATION:Subdivision:Subdivision: 41 la Ga Les Lot#: �b Lot Size: 3c
State Road# 1 11 C6 %0
GSttaate Road Name:hVim+ I C. kE$1 . Rzp{ 1 - '�/ 1Map Book&Page.$\7 /3
Parceel:7(\b '` 0I � V0 1 PIN: `-'s VI —ala -uoeq csoo
Zanin¢V' ood Zone'. O Watershed Deed Book&Page'7-U 5 / J`9 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(w/w0 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_Oft 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:
O Home Occupation:#Rooms: qqUfi¢:sHours
lof(Opp�eration:: #Employees:_
LIAdditio&Accessory/Other(Size (U xpG2 )Use:� /1),i- (.Ge) " �J�l ^, losets in addition?( )yes (_)no
(0x2 SJ4TOO et"- �4
Water Supply: ✓County Existing Well New Wel(#of dwellings well )'Must hay perable water before final
Sewage Supply: New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) '/County Sewer
D oes owner of this tract of land,own land that contains a manufactured home within five hundred feet(500)of tract listed above?( )yes (• fno
Does the property contain any easements whether undergound or overhead(_)yes ()no
Structures(existing or proposed):Single family dwellings: Manufactured Homes: _ Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum Actual
Rear
Closest Side
SidestreeUcorner lot
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DI CTIONS TO THE PROPERTY FROM LILLINGTON: `v / U �V 4C 4'a- a
'071-
x/7 or1 (LC_ Eek ua dr gig/v/-
1f permits are granted I agree to co • to al •finances and laws• : -State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing . en _ - -• ur[ate and corre • I _ est of my knowledge. Permit subject torrevocation if false information is provided.
Ignatureof Owner• Owner's Agent 177 Date//F
'It is the'owner/applicants responsibility to provide Ole county with any applicable information about the subject property,jpcludtng but net limited
to:boundary information,house locatipn,underground or overhead easements,etc.The county or Its employes are not responsible for any
Incorrect or missing Intormation that is contained within these applications.'•'
•
"This application expires 6 months from the initial date if permits have not been Issued"
•
•
r M
Residential Land Use Application Page 2 of 2 03(11
Named County Central Permuting O Box 55 LingIon NC
.«se
arenbeewteheMedad 5108037525Pu01 2793 wow Smolt Warms
by Winw,w pertaining work
kat b.nor Keened
canted r Mess angry
mora&phone mat mach
Crows Name idta .( .,offetegDat. a Da 8
Site adeno 574 %c. e / Phone /
orae60118 gsb see torn Ldnoton uw ? Et. o Laces 1 —
®L� fine..t (I'r rat, / ,P D.-i ,2/s 1-
Subdlvson &FWD GoIe S �7 (ot SD
Oesatpbon of Proposed Work Steen too J',s��rbn.•7/UlOr/ra6M p of Bedrooms 4
Nested SF a unheated SF Finned Bonus Rooms J_Creel Space�'s Slab __,[
insuanntamaitzroiken
Qw,er
Building Contractors Company Nene Telephone
Address Email Address
Lames K / Wow
Description of Work /ere^iU/( � v TEr Bae (Vb Mps T-Pole Yee 1No
MterrefeS l:��rls .al/bi r .. ((110) 0941— tin
Bean*Contractor Company Name A Telephone
5N04 Frew in& P1 5ticp,...tldriatetioi.seil.Cow
Addr.. art 74 L. Emw Address
License I
sum
On " olyti kP de AA/;
y i s 44 d Cr v�)701-346N
Tele
OCC 'I PDX ('u4h j ti 2Fiji AddressEm.il�eJAad�Gw�44.5 y*tit .614^
1076 k3—/
Loran*
Desorption of Work N Baths
Plumbing Contactor s Company Name Telephone
Address Email Address
License.
laudasacamendatamahon
flit scto tr-'
Insulation Contractors Company Name&Address Telephone
'NOTE General Contractor must full out and sir the second page of the 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 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)v sranrno below I have obtained all subcontractors
permission to obtain these oermrts and if any changes occur including listed contractors site plan
number of bedrooms budding and trade plans Environmental Health permit changes or proposed use
changes I certify it is my responsibility to notify the Hamett County Central Permitting Department of
any and all changes
EXPIRED PERM r E 6 Months to 2 - 1•- mit re-issue fee is$150 00 After 2 years re-issue fee
is as per cups - ar ule
1 •/ N/o3/ ,'8
S •A ure of • -r/Contractor/• -icer(s)of Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The undersigned applicant being the/.
General Contractor ✓Owner Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of penury that the person(s) firm(s)or corporaton(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
AA GilaS�G ca
Company or Name
Sn wrtee /i �DDate _ �3
Date '4/3/1
Plan Box# I —1 l 0 Job Name /U Q.n S-&a i
Plan Name
App # �� rq(6 Valuation lig; I (AO SQ Feet y.4, o
Garage
= (74oD
Inspections for SFD/SFA
Crawl_ Slab_ Mono_ Basement_
Footing Footing Plum Under Slab Footing
Foundation Foundation Ele. Under Slab Foundation
Address Address Address Waterproofing
Open Floor Slab Mono Slab Plum Under slab
Rough In Rough In Rough In Address
Insulation Insulation Insulation Slab
Final Final Final Open Floor
Rough In
Insulation
Final
Foundation Survey_ Envir. Health_ Other
Additions/ Other
Footing
Foundation_
Slab_
Mono_
Open Floor_
Rough In
Insulation_
Final