DOCUMENT Initial Application Date: y C'I 11° Application# I !S Sr)
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Ct#I
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.hametlorg/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED/ WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER: �ArvnP C°A4 w� Mailing Address: ['PO 130Y lo/�
City: AM, State:State:/1C.Zip': �7SDI Contact No: (4p-637-gin road:
APPLICANr:�uY nil Iovddly Illfr/C Mailing Address: PO d'11 2J35
city: Any)L✓ State/VC Zip:a74 I Contact No: 9/9 fly33Sy Email:
'Please fill out applicant information if different than landowner /� !
CONTACT NAME APPLYING IN OFFICE: Il//yy.i�tcni Phone if (9l% - Z).4'-l? y G
PROPERTY LOCATION:_Subdivision: c`_ - rte/ -+rJ,� '� - Lot#: Lot Size: I '� l
State Road# SI(.O State Roafd Name: �-*Q' 1 ' 1 uvv\k'5LA'\ Map�B]ook&Page: 1 / 1 OC
Parcel: ICC I U� 13 I PIN: � ,,I((I' S- 7 - Ia`PO �
Zoning: L3Flood Zone: X Watershed: 1211 Deed Book&Pager 1LAhA/ ' I Power Company:
'New structures with Progress Energy as service provider need to supply premise number�r� from Progress Energy.
PROPOSED USE: L _
Monolithic
�x�j(
SFD:(Size )#Bedrooms3_#Baths:.Basement(w/w'o bath): Garage: Deck: Crawl Space: ✓lab: Slab:
(Is the bonus room finished?( )yes (fro wl a closet?(_)yes (_)no(if yes add in with#bedrooms)
❑ Mod:(Size x )1!Bedrooms_#Bates_Basement(w/wo bath)_Garage:_Site Built Deck:_ On Frame_O#Frame_
(Is the second floor finished?(_)yes ( )no My 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:it Rooms: Use: Hours of Operation: #Employees:
❑ Addition/Accessory/Other:(Size x )Use: Closets in addition?(_)yes (_)no
Water Supply: (County Existing Well New Well(#of dwellings using well )'Must have operable water before final
Sewage Supply: 1/New Septic Tank(Complete Checklist Existing Septc Tank(Complete Checklist) County Sewer
Does owner of this tract of land,own land that contains a manufactured home within five hundredfeet(500')of tract listed above?(_)yes ( )no
Jay
Does the property contain any easements whether underground or overhead( )yes ( nO/
Structures(existing or proposed):Single family dwellings: Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum Actual)1
Rear II[[JJ���/�, 822 S'..
Closest Side l " J<)
Sidesireet/corner lot
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
w
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
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 foregoing s(ta{tteeemm�'$Is are ra d correct to the best of my knowledge. Permit subject�bjto revocationicaif false information is provided.
gnat Owner Agent /^Date
e.
"'It Is the ownedapplicants 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 for any
incorrect or missing informetlod 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
SITE PLAN:
SURVEY FOR: 8.10"qM
SOUTHERNP.O. ^TOUCH HOMES, LLC a_,rr(N•+9rO'O .
NEILL'S CREEK sTWP.. HARNETT�COUNTY. N.C. �?tlO`` • IWWYY• SS
47 DRAWN BY: JOYNER PIEDMONT SURVEYING ~•
3 beg
401 Nesp, Matt..^..490-2511 1e. oN.C. sans •
ZONE: RA-40 wnonAPRIL IS. 2018 ... SCALE: "= 60' '4 H.3oe
. 477in
NOTE Survey homy all of Lot 3 of the -Tyrone Roy Cobb 3ubdWbbn"
. shown on Pat recorded In Mw 2018-100, Harnett County
Register of 0eeds.
y _ NOTE Deed Reference: Deed Book 1164, Page 901
PIN 4 0871-83-1220.000
1 4
•
•
r eda• Albert Sidney King
p., Deed Book 2828. Page 313
f 'Plat Cabinet 'F". Slide 568-B
A\ /.e0
n
R ONNNN
1.595 Acres Total
Gory Lee Olive -0.104 Ac In SR P/W
1,491 Acres Net
Deed Beak 1089. Page 936
Mop *2006-439 g
1t 6I N
.
1:t5
I
s rl 9
3 IIIm "Tyrone Ray Cobb Subdivision"
N
Deed Buck 1164, Pogo 901
Map p 2018-100
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NOTE:.0 .e Is narlkII"eka
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M+earsif to wash,.
NAME: APPLICATION#:
*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 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 at/for Central Permitting.
• Place orange Environmental Health card in location that is easily viewed from road to assist in locating property.
• If properly 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 verity 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.
SEPTIC
If applying for authorization to construct please indicate desirededsystem type(s): can be ranked in order of preference,must choose one.
11 Accepted {_} Innovative I ✓i l:onventional 1-1 Any
{_} Alternative 1I 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:
1_JYES 1_frv0 Does the site contain any Jurisdictional Wetlands?
1_JYES 1_1--Pt4�0 Do you plan to have an ith2ation system now or in the future?
1_{YES 1 NEN.:EY Does or will the building contain any drains'?Please explain.
{ }YES 1 l NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
{_}YES 1 "JN9 Is any wastewater going to be generated on the site other than domestic sewage?
i_JYES 1 ✓J NO Is the site subject to approval by any other Public Agency?
{ }YES 1 y'NSY Are there any Easements or Right of Ways on this property?
{_}YES I_ NNO 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 Thal 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 Accessi �SooTT/haaatt A,Cf plete Site Evaluation Can Be Performed.
1b'IV 5 y-`JE
PROPER O EB O HERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
• OFFER TO PURCHASE AND CONTRACT
•
Scya.i+ oc*aAa� as Bayer.
hereby offers to peese and -neneaA as Seim
sea aaapana of aid 0R0,spots to sell and ooa4 dofthal plot piece or paneloflend dormedbdew,bmPom with ell tmpwaoob
I. baba therm and melt penal property L L lLMd bew.,(the mil and pampapbpdy at collectively Shoed to as"the Prorate),in
edam with the Sumba)Provisions on IS REVERSE F and ora be following ems sea 000then:
' I. REAL ERCIERRIY; ••Lthe CSV of i Rids 604 Cara Of.
A . .. -ofNnfh• ,.' .. . pv*tddydss -
admae
neo P!a y ,..i-• to Ce/
+aealD.wkeae -!� G'!f?l- moi_ �/fr. - . a ��egee a-..as
2. PBBSONAL PROPERTY: Ahmac
3. The potrhasepie is $Q d 0.t ad sell be paid as follows
(a) f AO earned looney paid by (®k bbc�%certified or peoaY tom)
with the delivery of this coaect,to be hal in maw:by Tw ...e C.e4r
is pat,mtll the sur L closed at width time it will be eaditE to Buyer.or vW this amen is oloai e
fmlaad and iii disbursed L aceordece with the Stands Aorta=on the REVERSE SIDE)PREOP:
(b) f neeNE by se.apla of tie mp.idwi.ciçal balance and all obapdaa of Sao co the eeita%its onec.d bye
deed of on m.Fngty:
(e) f Nea6 by a prod¢any note secured by a pate=any deed ofmat en the Pmpeny wilt Stent prior to debar
et 6e silo of %p atm=pgabla m Mows:
Ayrymem rmbdas oda pasha,if mit MAR be
Assumption ortrent rige4 if ansaeS bc
(d) E 1 ®AO theam Islam eftc pees dprim in eh at Meek.
4. C ON& (Stem WA b mai blink ofpmyTh 4(a)and e(b)bar not a modifies tthis contract)
(a)The Boy:mon be able to obtain a mm commitment to or before NONC effective through ou dab of dogleg.
bra dyed, loan in the plonpl a®t& fl & On ofat (s).at a Lamont
orbs to awed p %pa am®,wit motpp lea discard points not to sed /A9- %of the bas sown BOW apace
to is by beat efforts to recce such commitment and to advise Sena immediately lop=s®pt of the leader's deduce.If Seim Lb pay my
ism closing ost tom cons are as blbyn:
(13)The Boyer must be ebb to assume the unpaid pulpal balance of me meting Ian dented ia parpph 3(b)siert car the malady
of be loan can,at in dvat jab not to exceed. - )E%p Isla (m e typeloan) LARVAE
*St mongmongerlout assumption Exam dilemma tan at to mead A._ bermof
%oldie)ono balsam(See SteodadRoebloo Na 2)11sude
assumption teptn N.lender's approd,approval item be ranted on or beam NeVG Bev Ipw to ere his
brat efforts to mane mach spirem end to advise Sell=immadpody atom hie amp of the lmaab dnda If Seam le to pay any Hoa
assumption oats free outs w ss falai: DIJ
(e)Tbae Sit be a restriction,easement,=ping or other amnmnmlal z olatxm that mould;meat the tatm,Ne me of the real
papny er __ s�ae-rid4ec tJ 1f oeprm.
I.ASSESSRIDY[B: amat to th=e w a:pedal:easeo a.err,ctiScammed for dhw&,ping,vas,sewn
m other impvwmaL en m rdbiuep_Ne pmmly,amp m Totem: L'
6lON� (Lstet"Moeori4aiEtWi of ads maemmte,if m.The.gramme
ort payment ON pima of say.nt®ats Samba le to be at bed to paegmph 6 Mow.)
6. OTTER PROVISIONS AND CONDrnONS t
(a) All cilia Standard Provisions a to REVERSE SIDEHEREOFam understood ad shall aspyb NL IS except be foliodp
numbered Beaded Provision shall be dent& (Boone ere to he deleted stare loot)
Sale Su Ljec+ +0 +Ste thy is IM of Tike proper -e tA40 414-10
jofS of 4-At Sellers eypetse.
Sale
lecloc#
ing4 (0 rs e4SSPelt ?Led Fi'es1
eoa`
y burets xpe
P THERE ARE ANY ADDENDA TO THIS CON fRACI.INDICATE ABOVE AND ATTACH MUM
T. CLOSING: All Patin wee rowsmm say mod I doonats Rod papa etcee:yL with clmtg and hada of tie
a at bQme A,I f Vth a0f at a phewddgald by 3eyfC�'
The dadla to be made ie ate ar IA tut .L
etOwswy
le hmesiibaBb.baa armed yoseemlom I.netawmedaabel . a. *pabthe a3.se(
aim off V Nate
p dry from ad Iocludhy ante doles/hi to and Lcbdmg the dale ON pomme is to be dctiuttd a Mme ort*db.
9. COUNTBRPAM m: This offer shall beam a bilin=mat wheal rignd by bobah B orad Sd1:.It is to he signed in
cmrdapata with a signed mmeaput being retinal by ach pay hereto end the rearm pmt,if ay.
DemoiO � e ( tr Dab ofm/Tyf'
Buyer (SEAL) SEL `
(SL)Buys (SEAL) SELLER E
I body.chit dedp tearoflbs aura moray Sala dfan and apse to Iso$and arose eu n.e a.cmtm ntth Loins mesa
M1. .Thi/b," yam
ny irate Cor V
0 Zara Apr
gi &haw Ames= bin 11 Da Ams
Di Mai(0001
RNDmT tweets AgatlPua tag. DI awes
TI*81100=1 Fn =boon NORTH CAROL/NA BAR ASSOCIATION.reseal
ww.blawy bas: NORM CAROLINA ASSOCIATION OF REALTOR?,NC..aeae v.eaa t.wa•em
STANDARD PROVISIONS
y / 1. LABN66I MONEY:le Se canter offer is notnpbd. Provided is suis men.* ern such apcetona mm be
/
arab.evntaq ro
. of the ndO)on. completealibiingat
to are esatisfied, completed in at e before data te Walt say nae
et a thea t af.brad,of W.mart"by St.then the to be oomplmtl by elating. If my mph.erne®my Sella
camas mousy shall be relined to Brom.but suck ram slat Man hove We option of W cmpMmg tbm.@)welding for
not effad a other embodier mailable to BWa Wt such Mach that cambric.; or(c)redmbg to complete Than. If Saran
le the trent this offer is accepted ad Buyer breaths.this elects not ta emplace or provide fur We raysletion of the
contract than b omen money mall be Welled,len such opals,dun Buyer shall hen the upon of(d)accepting to
Thcthbe will at Met am CACI ramedlei.aha to Seller Pmpvty ad,Pas amdiion.or(e)laltdomillg this man*
for such mach.NOTM m the eetwe dimmed beam.Saga iewWeh we me ervzamoney AMU be ntadee Coag mail
ad Buyer err b morn or imbibes of tamest moat held In oaadae aovepuee of wok of the .plus. iter and
anew bye broker,to boat is aphed by ds law to roan °onLi—Barad in(1).(14),DIO end Uv)oboe in atm Maim
mid sanest money in bis nun ea maw amount mail he be. condition:nista provision is emmwieemadr in writers.
Jested a.often nam from ere pita anuses to it B BUYER OBTAINS A VETERANS ADMOSEIRAIION(VA)
disposition ar-traildbenrml is ordered by a court of LOAN, SELLER SNAIL PAY THE COST OP ANY WELL/WATER
complcutjuradictIon. ANDSEpflOBWEt SYSTEM INSPECTION.
I LOAN ASSUIm®: come event.l®°nam ed-wnor
RECOMMENDATION: Buyer shoJa Ion .q aa.dim.
me gamed of tel Purchase pia.ter al Mama due Itemmade pm m earring repaid fm claim.
Salle thereon mm be cmrmt J closing, and ea principal 9. WOOD-DPSTBOYING INSECT& UNos dhm.i.e
annce nod alt be accosted dm.3Ydcloiry.its need hone Bee mel bee le°peon NWdJey-ranee•
mor Mown for me uampton lobate and cab a Nosing =rooe a tport from•lamed pal°ental rperaer o•
man be.punted se•pparae at wring to reflect the tee ended eon m tcoamaa we to ry4eq=were Nan
mmpmdea&Hakes Buyer be.abawias ped(ieelbageed l Cad=Smconal Pa Cont Combines, tams that awe
wrung the misting la owe be uammorMe without MUT was no visible evidence of wnbdtauyag comb end
.cWa.loo of We amain seared or m neap in to Origin! coualefng en indication of'HIS dame'.plata.The rpm+
baa of as not•sod deed of mot Buyer mall be responsible mm be Obtained is.udds time balms doting se tam pawit
err at by assumption coats.Selo bH lam no aft nee to nra¢pt if any.ad repo.if q,M be complied Pro to
pry any Is assumption epos unless roacifia@t at forth In this doing.Al teams,rented mall he paid fit by Bala and
contact. To escrow amount,if any.shall he purchased by completed pin to doing, unless otherwise,egad upon In
Bum. writing by to prier If say.mond repairs are mammy.
1 PROMISSORY NOTE AND DERN OP TRUST. In the BeVee Manses b option w(.)ottnaoagWs.(h)porlmeg
ear.pamlrwyaa amveeyaSed riv°a bgay Air mm complain,a'(a)rhea m Ante mem. If Salter
Beyer to Seller es pone of Si puma*were purchase price,the
etas adm�bb eeproadsaboowmtlnrisusinl
pro nay me and deed of nisi shall be in die fain of and DVSs*mm BIN*mal bon IS matt of(d)atapmg to
amain the pmoroa of the aurtewdy approved N.C. her ■nparry a a puitom'We4 or(a)ammum1mia coma
•Ammeter Pas.•sod 5,is modified in paragraph 3(e)on b in Meth we the mea meow.hal ba abodes,IligaiggEJa
mare side beet.
a. PWRATLONo AND ADJOSMaMe'pr Unl as omewbe n•. r te
provider; the followedpabete mall be pnnW ad ether derentet imB Bales shall protea avewlsmmbeama
apui b=ean the poen or ped at closing gmmne.
(a) Ad Menai mot on real petty Mail be pon=d on a BUYER OBTAINS A VETERANS ADMINISTRAITON(VA)
• yeabets mthe pe of eloiSE LOAN,SELLER SCALLLPAY THE COST OF THE WOOD
(b)
(h) Ad aelab lam en permed ncetw a the mea you 10. LASYRJOPB¢CTRBPMT.
AJlbapidy Salim ia 10. WOR AND MATVIALi Behr Mall lint at dosing we
(c)ReIon .,. pmatmeif tysshall pe rorated
tothed affidavit and ademdjmtim.Renta*m mm siid•caryto
(p Eon,i[ap,for the Poverty shall bapaefed roma date of Bum,towing ern all labor and maeriala if.y,Masodto
Pee lo le Ma of cloth*hem
(a) Amnia bat unpaid lagan and oto charged Selo,if lam P and agreeing to 1 Lmdmntl Boyar Plat.LL yes
rax shell a erding b dm of dotes m paid by sera. Om any cam or Maim'Ming mteom.
comm sad neer
r dupe Aped by Selo shall be modlad to
Sallee a clams and paid by Pugh(Other Atha may hoist I1.WORD Bat yea to purchase from Seller the fuel,fay,
PHA romps.barna pa.aa ,private mortgage Munoz situated m the Properly at the retailing rs.wimb
premtusedban sudation donof mei'sr s) amruass thamf,if my,being mid by Selo.
5. FIRE AND OTBER CASUALTY: The risk of lm or 12. CLOSING EXPENSES: Saha call pay for the
damage by he or°ms,astir pier to emmb mal ke pen Apnea of a rd m lar the aim m(Mane sump.)
Seller. required by lon. Byer shed is err recording the deed andb
6 CONDITIONS: . papaMdon r.aouNh:g of W inertlebee nada!to maim
(a) Ta Property man be la subsmaally the..m option at b balance of the Manan pica cpm a caring.
closing as on as do of to offer,reasonable wear and bar 11. EVIDENCEOP TITh: Seller sane to me his best
melte. carte to Mbar to Bayern am
do a mebb' ntil
pae aur me
0)) All beds of etc. tams and nee obtgs against the ampaToS of this oft, corm of all title SRmNn a
Pnpeny,not ward by Byer,ata to paid and cancelled by possession ova available to Sella including but ea lead b:
Sala prior to et at dosing. eh ammo maul, amnnyt Mama on titin army.,
(n) Ma an be latae t JaIR by morel warranty deed comma deeds.ma.m deeds of tut am erten rat(
and ma be b abaple marketable baa dee oval'nubaas to the Properly
nap"Winn'mai for We tat Wer(pored to the dais 14. ASSIGNMENTS: This curie*may net he wined
ricking;utility elm and tawidmd restrictive co.n.ntl wan me weer•gamic of el
porta.a If mipsd by
out do not meanie*ahem the valve a b Property sod sot agmameL tpyti canted aril be bindles on the enigsn
Mew nulmeep es maybe tanned Or pafwal1y approved shat ere rumwm..
by Pym. The Property mm haw awl moms m.Pdde tight
neve 15, . PARIES: Ibis servos,shall be baring pm to shall
T. NEW WAN! B°yv mW aregmahle for all caatl Min to tie bath of the pertly sod their Memaethe as
Meet a say mw la obtained y Bye.Salt ahai!Ma no ande.A.tN.arias
sMem &•m Maudethe
dlaaaa te Py ay chanes,b or wear chew M ea.meme and-the mover.Lames m.*minim sod muter eadae.a
drneem=Maapetfiialy sat Ilam In this ceenaet �Olme
B. OaricerIONs: Unica otherwise muted Merin: (I) the IG
asapBRVVA
seeQn' fay pmveoahtSn emaa lti&ya
olivae kept ain
Jadal.plmbaghurting end eel* incyaWallinafterb d®S.e
required to
amore and amainbinding
N Mg NO be in good yoking odor J claim ppfatrdmeflribparties hreloual ddlobave
( ) the root Paas. smwlunl components. fouodaimkept o
fir
thick d a andmy(Ommap=ed of
HMS.for 17. Irani Atimfl1T Buyer atmnbdsi tar be be
thick ie sell be no
mitalabteea i emw4dneo:
MO dime moaamwa s/draper emditumaevi and
tapioca aa Pang Mem
erepmati ncmseeaat
• time moat=edvaeel.B•Ay b mml men he and adequate,
other er para. thou th a wpmwYaiw. All a
nt In—of dedit rearaaseebmiag eaac on Mr rons deletions imttbaeaaprsedbalsod.a elmo
°tih etewmmairletpv aMpaMmlybbtWna rimveainCon drosy Mm es say sated
which aadsd Buyer shall a neve the opo to have re ohm Pathe. Noels t orrd em slat to ma .peau
lbMd past.las. . e muyer pal=( le.otna batmen•PBA oelata and Seiler a. may
apps er awr.M. et BuyerY caper (mlur ntherwive lisagcoaatceabm apeunbenameu.
UNTY CASH
HA*** CUSTOMER RECEIPTC*.0TS
Date: J4
Ty pe: CP Brauer: 1
Bate: 4//228i0/18 52 Receipt no: 329223
Year N43847
Amount
2818 58043847
91749 TECH 2
BILLIHGTOH, EV 27540
ENV HEALTH FEES
B4 4750.08
NE0 TANK
SOUTHERN TOUCH
Tender detail 3 $758.00
Cl( CHECK RAINEH 123 $750.00
Total tendered $750.00
Total payment
Trans date: 4/20/18 Time: 14:13:01
** THANK YOU FOR YOUR PAYMENT **