DOCUMENTS Initial Application Date: q I i a l 1 O Application# a Str-/ 3'7S /
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.orgipermits
"A RECORDEDDSURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPUCATION"
LANDOWNER: Jeff N
OUII Mailing Address: gni /empk Road
City:wAA kW/ State:a C Zip:c283.23 Contact No:26-a)41-6395 Email: ✓d6 /lee c 2d)i Ma jcoaPT
APPLICANT': Mailing Address:
City: State: Zip: Contact No: Email:
'Please fill oN applicantiinformation it different than J4f+ AC landowner ')
CONTACT NAME APPLYING IN OFFICE: - II / 11 Phone I( 9/6-643-6393-
PROPERTY LOCATION:Subdivision: aQ /`/l.AJJ a� -( Lot#:a PJ Lot Size: I'90
State Road#-1 I State Road Name: I _C-t^'pIL ttC 1 y� �7 Map Bookok8 Pag^e��1IAf £
Parcel:plr�[Jvv-nD St-in bbu � -h4 PIN: U�GY I p - aO lOa.000
ZoningRN/D -Flood Zone:Y. Watershed:/l,,.r7 Deed Book 8 Page JO 4 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/wo 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 _U Baths_Basement(wiwo bath)_Garage:_Site Built Deck:_ On Frame_Off Frame
(Is the second floor finished?(—)yes ( )no My other site built additions?(_)yes (_)no
❑ Manufactured Home: SW DW TW(Size )#Bedrooms. Garage:_site built?
( _)Deck: (site built_)
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use. Hours of Operation: #Employees:
❑ Addition/Accessory/Other(Size d4 x 34)Use: (DpfOAC Closets in addition?(_)yes ( )no
Water Supply: 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 (Zino
Does the property contain any easements whether underground or overhead(_)yes LILY no
Structures(existing or proposed):Single family dwellings: / Manufactured Homes. Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum 3S Actual
Rear 'DS Nom
Closest Side O
❑ estrteUwmgr lot
Nearest
onn esamam e lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Ihoy 2t 4d,rcJc SOr.nN 4e k ; Cep art
/
•
It 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 foregoing statements re accurate an correct to the best of my knowledge. Permit subject to revocation if false information is provided.
/c7Apr/3
Si f Owner or Owner's Agent Date
•
•'9t 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.Th?county or Its employees are nbt respohslble for any
incorrect or missing information that is contained within these applications."'
"This application expires 6 months from the initial date if permits have not been issuer
•
Residential Land Use Application Page 2 of 2 03/11
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NFLW 1.3 5-31 eilfgai Harnett County Department of Public Health 23058
PERT# a-1C 64 Operation Permit
New Installation Septic Tank' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: —Moto z4. Qll
Name: (owner) Q.C. Ws.1-.w.,.s Ca.q, ,C-0• SUBDIVISION 'S[.FF 1auLOT # OLP'
System Installer. Gtiao.+-o l. nvi-t Registration #
Basement with plumbing 0 Garage X Number of Bedrooms�/ y
Type of Water Supply: 0 Community ' Public 0 Well Distanm from well I M." feet
System Type: .1L1�e Types Y and YI System expire in S yeast
(In accordance with Table Y a) Owner most mild Health Department 6 months prior to expiration for permit went
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ism b btu SSW n asplS 'th appI Ns NeM San Gwen]Sows Ades fa Srwµt Truism of piped,ad a maids d S ap.mmr Penh me SUMS ASK boa
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PERMIT CONDITIONS:
L Performance: System dull perform in accordance with Rule.1961.
IL Hankering As rewind by Ruk.1961.
III. Maintenance: As required by Rule.1961.Other
Subsurface system operator required?Yes 0 NoX
If yes,see amched sheet for additional operation mndiuom,maintenance and molting.
W. Operation:
Y. Other.
0 D-Ben 0 Pump 0 Alarm ❑ 112OLine ❑ PWR Line
following art the specifications for the sewage d'uposal system on the above optioned property.
Type of system ❑ Lommdonal Other EZ Clew Septic Tank 100 0 glom Pump Tank gallon,
Subsurface exact kngth width of depth of
Drainage Field di �- of eath ditchC 6 feet ditties_ 3 kW ditches 1W inches •
Frends Drain • : •
Authorized State Agent AVt � DF3t5 Date 1'4513
NAME: T d�F No I) APPLICATION A:
*This application to be 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 I CONFIRMATION#
Environmental Health New Septic SvstemCode 800
• All properly 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 at/for 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 (after 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 ltd 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
it 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.
SEPTIC
If applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference,must choose one.
I—j Accepted {_j Innovative I-1 Conventional (_) Any
(_) Alternative {_j Other
The applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in
question. If the answer is"yes",applicant MUST ATTACH SUPPORTING DOCUMENTATION:
{_}YES (_j NO Does the site contain any Jurisdictional Wetlands?
( IVES {_) NO Do you plan to have an irrigation system now or in the future?
}YES { j NO Does or will the building contain any drains?Please explain.
l_IYES II NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
I_IYES {_) NO Is any wastewater going to be generated on the site other than domestic sewage?
{_}YES (_A NO Is the site subject to approval by any other Public Agency?
{—AYES {_j NO Are there any Easements or Right of Ways on this property?
{_}YES { j NO Does the site contain any existing water,cable,phone or underground electric lines?
If ycs 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 Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site Access'• e So That tete Site Evaluation Can Be Performed.
� /a/�y�/S
PROPERT Jr/ I ' RS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
HARNETT COUNTY CASH RECEIPTS
*** CUSTOMER RECEIPT ➢raaer: t
Oper: JBROCK Type:
Date: 4112/18 52 Receipt no: 320326
Year Humber Amount
2818 58043769
1104 TEMPLE RD
B4NHLEUEL, NC 23
ENV HEALTH FEES
B4 CH BB
EDT TANK
JEFF HULL
Tender detail CORM CREDIT CARD $106.430Total tendered $100.80
Total pay
Trans date: 4/12/16 Time: 15:10:38
** THANK YOU FOR YOUR PAYMENT **
09109111 Application#
Harnett County Central Permitting
PO Box 55 Ulnpton NC 27546
Each section below to be Ned out 910 893 7525 Fax 910 893 2793 www homed tegtpennds
by WhOMOVit Pertormol0 work
Must be owner or hammed
contractor Address company Application for Residential Burldma and Trades Permit
name&phone must match
Owners Name Tag; /4,l/ Date Q7IAprl$-
Site Address /1/A pay/e P) IX (eve /AJC _2E123 Phone 9/0-. ?-G39r
Directions to job site from Lillmgton a/O Sovi. / /r ft an T imp it
Subdivision hi" /nI (orgy'
Description of Proposed Work AA r fir/ ( orgy' #of Bedrooms
Heated SF_Unheated SF Finished Bonus Roomy_CravA Space _Slab
General Contractor Information
Owner
Building Contractors Company Name Telephone
Address Email Address
License#
&ctncel Contractor Information
Description of Work Service Size Amps T-Pole _Yes_No
Electrical Contractors Company Name Telephone
Aress Email Address
UdpWA-Or
License#
Mechanical/HVAC Contractor Information
Description of Work
Mechanical Contractors Company Name Telephone
Address Email Address
License#
plumbina Contractor Information
Description of Work #Baths
Plumbing Contractors Company Name Telephone
Address 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 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 Dv slanma below I have obtained all subcontractors
permission to obtain these permits and if my 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 Harnett County Central Permitting Department of
any and all changes
EXPIRED PERMIT FEES-6 Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is as per currem/ fee ach ule
f�L]/ 274 /2
Sig of Owner) ontractorlOfficer(s)of Corporation Date
Affidavit for Worker's Compensation N C G 8 87-14
The undersigned applicant being the
General Contractor ✓Owner Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of pe0ury that the person(s) firm(s)or corporation(s)performing the work
set forth in the permit
Has three(3)or mare 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 Much this permit is sought it is understood that the Central Permuting
Department issuing the permit may require certificates of coverage of workers compensation insurance pnor
to issuance of the permit and at any time dunng the permitted work from any person firm or corporation
carrying out the work
Company or Name
Sign w/Title 7A40,727 Date a7APr 18
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Application Number 18-50043789 Date 4/26/18
Intersection
Property Address 1184 TEMPLE RD
PARCEL NUMBER 12-0547- - -0062- -04-
Application type description CP GARAGE/CARPORT RESIDENTIAL DETACHED
Subdivision Name EDWIN MCDONALD HEIRS PROPERTY
Property Zoning PENDING
Owner Contractor
HULL JEFF A & CRYSTAL N OWNER
1184 TEMPLE RD
BUNNLEVEL NC 28323
Applicant
HULL JEFF A A & HULL CRYSTAL N
WIFE
1184 TEMPLE RD BUNNLEVEL, NC
BUNNLEVEL NC 28323
(910) 263-6395
--- Structure Information 000 000 26X36 DET GARAGE / STORAGE BLDG
Flood Zone FLOOD ZONE X
Other struct info PROPOSED USE GARAGE / STORAG
SEPTIC - EXISTING? EXT
WATER SUPPLY COUNTY
Permit RESIDENTIAL BUILDING PERMIT
Additional desc .
Phone Access Code 1238278
Issue Date . . . 4/26/18 Valuation . . . . 0
Expiration Date . 4/26/19
Permit RESIDENTIAL ELECTRICAL PERMIT
Additional desc .
Phone Access Code 1238294
Issue Date . . . 4/26/18 Valuation . . . 0
Expiration Date . 4/26/19
Permit LAND USE PERMIT
Additional desc .
Phone Access Code 1238302
Issue Date . 4/26/18 Valuation . . . . 0
Expiration Date . 10/23/18
Special Notes and Comments
T/S: 04/12/2018 03 : 02 PM JBROCK ----
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 18-50043789 Date 4/26/18
Special Notes and Comments
HWY 210 TOWARDS SPRING LAKE L ON TEMPLE
RD
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Page 3
Application Number 18-50043789 Date 4/26/18
Property Address 1184 TEMPLE RD
PARCEL NUMBER . 12-0547- - -0062- -04-
Application description . . CP GARAGE/CARPORT RESIDENTIAL DETACHED
Subdivision Name EDWIN MCDONALD HEIRS PROPERTY
Property Zoning PENDING
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
Permit type . . . . RESIDENTIAL BUILDING PERMIT
999 103 8103 R*BLDG FOUND & TEMP SVC POLE / /
999 111 B111 R*BLDG SLAB INSP/TEMP SVC POLE /_/_
999 101 B101 R*BLDG FOOTING / TEMP SVC POLE _/ /_
999 131 R131 ONE TRADE FINAL
999 125 R125 ONE TRADE ROUGH IN _/_/_
999 229 R229 TWO TRADE FINAL _/_/_
999 225 R225 TWO TRADE ROUGH IN _/_/_
NA SOERECPTC* T5
0* CUTMR EI **
Opel: JOROCK Type: CP Drawer: 1
Date: 4126110 52 Receipt no: QN0833
Year Number
2018 50043709
1184 TEMPLE RD
OUNNLEUEL, NC28323-
1 PERMIT FEES 11268.00
DET GARAGE
JEFF HULL
render detail 4268.88
CP CREDIT CARD 8260.00
Total tendered 11260.00
Total payment
Trans date: 4/26/18 Time: 15:11:05
wa THANK YOU FOR YOUR PAYMENT xw