DOCUMENTS Initial Application Date: —1I G J18' Application# it soo42)S I
/ COUNTY OF HARNETT DEMOLITION APPLICATION
108 E. Front Street, Lillington, NC 27548 Phone: (910)893-7525 Fax:(910)893-2793 www.harnett.orgipermits
Lando ner ii i. . .L \.P,i/.,+,4i. Mailing Address: '7/Je-42/•/ 53);/Pt
City: a_ ) ♦ a.s /MA/ State Zip: g39a-tome#:49 I 1,F'-6 -.I Contact#:
APPLIC 'NT': . _ ,eta. . .Ii w Mailing Address: 7/ Q
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City: 4,1 II. a .. 4`r State!"YICZip C-qg Home#:94,S4 D1iO Contact#:
`Please i out ap�+x-.�n information if diffee ennt�than landowner (J
CONTACT NAME APPLYING IN OFFIC 24/be- / --einfi i 224-- Phone#:9in--p LS�/
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PROPERTY LOCATION: Subdivision: G Lot Acreage:
State Road#: State Road Name:
Parcel: PIN: 1 Zoning:, Flood Zone:
SPECIFIC�/rDIRECTION��O THE PROPERTY�F�OM LILLINGTON: o�I e /w') �i .�f 2�./1./AY�.(/)�7/
Structure(s)to be demolished 8 removed: Single family dwelling Manufactured Home //Other(specify)
Structures(existing and/or proposed):Single family dwellings Manufactured Homes Other(specify)
Water SupplyVCounty (J Existing Well
Sewage Supply: (V(
Existing Septic Tank ( J County Sewer
• If a new structure is to be replaced on this lot, please ensure that existing septic system is not damaged.
•If an existing well is on site and is to be discontinued, please contact Harnett County Environmental Health for assistance.
`Upon the issuance of the Certificate of Compliance, the Harnett County Tax Department shall be notified of the removal to
ansure proper listing.
The demolition contractor is responsible for submitting verification of proper disposal prior to the Final inspection.
"PLEASE NOTE"Failure to completely demolish, remove, and clear the premises will result in the withholding of the Certificate
if Compliance. Thus,future permits for the property will be denied,and fines may be imposed for failure to complete demolition/
emoval.
permits are granted I agree to conform to all°Sinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
hereby state that foregoing statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
4.e1 a AM,�.s4, -- 2/ - 9 moo/ gd
Ignat of Owner or s Agent Date
'This application expires 6 months from the initial date if no permits have been issuer
S:'Planning and Inspections Files'FORMSICP Forms
Asbestos requirements are applicable if the occupancy use is or changes to Commercial (not residential),
or if multiple structures are being demolished & removed at one time.
An Asbestos Inspection Report prepared by an N.C. Accredited Asbestos Inspector must be provided with application to
demolish any building including residences demolished for commercial or industrial expansion or structures. It is the contractor's
responsibility to propedy notify the Department of Health and Human Services Division of Public Health — Health Hazards
Control Unit at least ten (10) working days before the demolition is to begin whether or not the building is known to contain
asbestos.
I hereby certify that the information on this application is correct and that all work in connection with the above
referenced job will be performed under my supervision and that such work compiles with the requirements of the NC
State Building Codes and-applicable Harnett County Ordinances.Call for inspection at proper stage-of work. --
CONTRACTOR/APPLICANT DATE LICENSE NO. (H applicable)
Please contact the Department of Health and Human Services for their requirements and permit information.
http:llwww.epi.state.nc.uslepilasbestoslahmp.html
S:Planning and Inspections FIIesIFORMS\CP Forms
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call: (910) 893-7525 Fax: (910) 893-2793
Application Number 18-50043751 Date 4/09/18
Property Address 14 GREEN IVEY LN
PARCEL NUMBER 01-0515- - -0359- - -
Application type description CP DEMOLITION RESIDENTIAL
Subdivision Name ANDERSON CREEK HOMES
Property Zoning PENDING
Owner Contractor
JOHNSON MARCIA P OWNER
71 GREEN IVEY LANE
SPRING LAKE NC 28390
Applicant
JOHNSON MARCIA P
71 GREEN IVEY ST
SPRING LAKE NC 28390
(910) 568-0120
--- Structure Information 000 000 DEMO 2 SWMH ADDRESS 14 & 50
Other struct info PROPOSED USE DEMO
Permit RESIDENTIAL DEMOLITION PERMIT
Additional desc .
Phone Access Code . 1237502
Issue Date . . . . 4/09/18 Valuation . . . . 0
Expiration Date . . 4/09/19
Special Notes and Comments
T/S: 04/09/2018 02 : 54 PM JBROCK ----
210 to BILL SHAW TO OVERHILLS TO ARCHIE
TO IVEY TO GREEN IVEY
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 18-50043751 Date 4/09/18
Property Address 14 GREEN IVEY LN
PARCEL NUMBER 01-0515- - -0359- - -
Application description . . CP DEMOLITION RESIDENTIAL
Subdivision Name ANDERSON CREEK HOMES
Property Zoning PENDING
Permit RESIDENTIAL DEMOLITION PERMIT
Additional desc .
Phone Access Code 1237502
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
999 179 C179 C*BLDG FINAL / /
999 131 R131 ONE TRADE FINAL / /
999 820 Z820 PZ*ZONING/FINAL INSPECTION / /
HARNETT COUNTY CASH RECEIPTS
*** CUSTOMER RECEIPT ***
Oper: JBROCK Type: CP Drawer: 1
Date: 4/09/18 52 Receipt no: 315612
Year Number Amount
2818 50043751
14 GREEN IVEY LN
SPRING LAKE, NC 28390
D1 BP - PERMIT FEES
$75.00
MARCIA JOHNSON
Tender detail
CA CASH PAYMENT $75.00
Total tendered $75.80
Total payment 475.00
Trans date: 4/09/18 Time: 14:56:23
** THANK YOU FOR YOUR PAYMENT **