DOCUMENTS Initial Application Date:46 \ICS Application :SS SC)c1_LJ C-09
CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)8934525 ext:2 Fax:(910)893-2793 www.harnett.orglpermlts
•'A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
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LANDOWNER' �t b � �(` �,rLrp1kF,�0.`u. Mailing Address:��/t (� L��71I'L 0 1,��' ��y�
1"cu1r-N-v;x / • IV'L- 'J`, +�5Contact No:gbo T mail: lE&Ll)1tlkii lY �')il1IJ(})(a3,C`�' 1
City ,A I �F' State: ZiP: l p 1\ J I
APPLICANT'�J�r,�YfY1C' A, Owner Mailing Ad2ddrr�ess:�:If�I//p}}l f )'Au�,P✓O;/P/ 7Pfi,A�'�i')/(}ii veN ``11,,• 1430
City:
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City: rag lie Slate:tJCZipo ,_A:ontaclNo`I1O-Ypli Li gig Email:\FL fl/lV'4�dtPhhh(vne3LOM
*Please fill out pplicant information if different than landowner n n /� (�{ 6-.)(-1
CONTACT NAME APPLYING IN OFFICE:I/ Lea hl flct-/n� t-`lC //'' �/ �I P1hone# to- 6' L`�
PROPERTY LOCATION:Subdivision:ear!, Celen lV andery'ii I .reek. Oil b Lot It CO"^ Lot Size: 11) .t% b.t'
State Road# State Road Name:
Map Book&Page:2014 ,2.u4
Parcel: otO511523 COO t% PIN: •SOC Sb - l4 ! O . 000 p
Zoning:f.(j'D4)R Flood Zone: X Watershed: X Deed Book&Page:34%4 / DI O'ZPower Campany`0C 7.)t:-t%n alvei
premise structures with Progress Energy as service provider need to supply I number from Progress Energy.
PROPOSED USE:
e Monolithic
t SFD:(Size 3�xS 1 )#Bedrooms:3 #Baths:3.Basement(whvo bath):_Garage:_emir: Crawl Space:_Slab:.Slab:_
(Is the bonus room finished?( )yes S.) �Y
no w/a closet?( )yes Y"no(if yes add In with#bedrooms)
❑ Mod:(Size_x 1#Bedrooms_#Baths_Basement(wlwo bath)_Garage:_Site Built Deck:_ On Frame_Off Frame_
(Is the second floor finished?( )yes U no My other site built additions?U 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:
❑ Addition/Accessory/Other(Size_x )Use:
Closets in addition?(_1 yes f )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?(J yes (y 1 no
-Does the property contain any easements whether underground or overhead(Styes ( )no
Structures(existing or proposed):Single family dwellings:
I Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
� t/�
Front Minimum n^�1 Actual2.0$
�Z
Rear ( 30.Zr1
Closest Side 5 9•5)r
Sldestreet/corner l_ l b
•
Nearest Building I� )
on same lot Page 1 of 2 03/11
Residential Land Use Application
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PRO ERTY FROM LILLINGT l N �Utri r ��� OrSQcl{�l.�t� [�
Turn k+ (Air) KO } �2Y.XCI . [vrn l + 1 f. d
-e;f- T v-) 't.1< F r t ve
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 slate that foregoing statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false Information Is provided.
441t1-09sSignature of Owner or Owner's Agent Date
*"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.The county or its employees are not responsible for any
Incorrect or missing Information that Is contained within these applications."'
**This application expires B months from the initial date If permits have not been issued**
Residential Land Use Application Page 2 of 2 03111
t MICHAEL P. GRIFFIN , codify That under my direction and
aM.wwn fhb map .w ten from an actual field s mat the acae of
down of the!Wryly as calculated by emMofu b I: )AIXtl.: that Me
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OPEN SPACE _ 8.83'
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SITE PLAN APPROVAL o I
,� I s'UTILITY��'R��ou�
D STRICT a22l USfi5� / _ EaSEMeNr
YDEDROOMS 3 CI 1
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4h% 11 z' GLENSIDE N
Zoning mlMetm or COURT
REVISION. NEW FLANS 4/10/18 50'RAW .a
CI R=50.00'L=49221572°1 I'17"W4726' LEGEND ` ..
PR R I IAA IN A RV I EF EXISTING IRON PIPE FES IXARM FNn SMTInN ME
09109111 Application#
Harnett County Central Permitting
PO Box 65 Lillington NC 27546
Each section below to he filled out 910 893 7525 Fax 910 893 2793 www hamett orglpermits
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name&phone must match
Owners Name 14 le0itrLditS (3R-FLt1/40-kt Vi IIP, L 0 Date 4G41101%
Site Address ZS b.�.s..�+.r�-t- fit. Phone q In--L1 gin- t`1 g(0 LI
Irections to job site from Lillington a u 115 nil ' . 1 )1( .rnfl
Ailoilott.) Rat( `� R(I
O . Urn lett. ettx +
l IloW
(�flC\' r`SQn C ,rets tr 'lvc .
Subdivision( (lrricseGIrnCL Mirk/3'3n (' reeK 010b t Lit ASS
Description of Proposed Work Klett) ci.
rY IE,Fan i ki LI4;E16.).:6 #of Bedrooms _
4Heated SF Nat*unheated SF totli 4Finished Bonus Room'r hes *Crawl Space _Slab x
General Contractor Information
11frtlCvr r-uctt,rc, of Ccx,1e,Mai,Ile ill (1�, 910-'IV°- 'lgb14
Building Contractors Company Name Telephone
-Qrll'iBreeepionl Ave S-k.1100 is' .IcG. an. 63 kcwnlmir +Phhl,,v,e5JoivI
Address Email Address
'141`. 3
License#
Electrical Contractor Information
Description of Wnrk Service Size 6O3 Amps T-Pole Yes_No
J M Pape' `LIessi-rici a-rt, _ dlIcl lrllo-r1/4 1Lig
Electrical Contractor s Cbinpany Name Telephone
LOCI 0cd-lrarn Skre .t ;CArrig tNiV 1'1; • F • ._ 6bnrr -,
nuaress Email Address
al3atc
MechanicalIHVAC Contractor Information
jR escription of Work
(]naalinc:. Ovm-fnr-} Air Jrxi . gICI- c131-1 - 16163
Mechanical Contractors Company Name Telephone !�
:Fiala ()S i-I I -1O ? itSine SS alta(ton fill ('r,rolince lr Lhootl'yyy ,CO rjj
Address a-1 5a0 Email Address
al01114 -3- 1
• License#
Plumbing Contractor Information
Description of Work #Baths a_ 4.
•Vnrre ,hhncnn PIornbingeo tInC, . 110-L1a4-rola
Plumbing�C^ontractors Company Name' Telephone
:3.:$4411'1X1 Pie RYadd r at/ell-vi 1k f ICC Sk'O(o 1Kin'i .to Lc tip'0,1161.(Orn
Address Email Address U
(VJ7Sio- P-- 1
• License#
1 Insulation Contractor Information
fl- ,c,+ilJinsviccr;onlnc 4iPew,�nSt, ( 9IU•-L44((e x'55
Insulation Gbntractors Company Name&Address 033 i Telephone
*NOTE General Contractor must fill out and sign the second page of this application
I hereby cerbfy that I have the authonty 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 sigma below I have obtained all subcontractors
permission to obtain these permits and if any 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 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 current fee schedule
—Par t-L 1-3 c7-, f.-t- U ' t 2 `I 91
Signature of Owner/Contractor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation NC G S 87-14
The andigned applicant being the erg
General Contractor 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 fo 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//
y 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 d 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` ` 1 1 (� f (�
Company or Name 4 \\ 1.6^1..0 0C c�onaVALtit. cLL
Signw/fdle �l -. (%nsl&_--- I 0)rfY?r'�}i/1t;l� orzifirTiasio
Appointment of Lien Agent: Details - LiensNC Lien Service Page 1 of 1
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 04/10/2018
Entry #: 831736 Initially filed by: meaganbradsl aw
Designated Lien Agent Project Property Print & Post
First American Title Insurance Company CGA000985 Lot @5 Carriage Glen @ Anderson EI-. O
Creek Club 'k4' 4.
feline: xwlimmu wm+�-..-.�. 25 GLENBEND COURT 1 N 5.
Address 19W Hagen Si,Suite 507/Raleigh,NC Spring lake,NC 28390
Damen County
27601 Contractors:
Phone.83EL90-7384 please post this notice on the Job Site
Emnl<mm�nn.o.zcon Property Type Suppliers and Subcontractors:
. ........n.m Scan this image with your an phone
view this fling.You can then file a Nonce
to Lien Agent for this project
12 Family Dwelling
Owner Information
H&H Constructors of Papal:mile,LitDate of First Furnishing
2919 Breecewond Avenue Ste 400
Fayetteville NC 28303
10/04/2017
Email leannahain@hhhomes corn
Phone 910-486-4064
View Comments IB)
Technical Support Hotline:(888)690-7384
https://apps.liensnc.com/scr/appointment/details.html?entryNumber=831736&printable= 4/10/2018