DOCUMENTS Initial Application Date: aj-I S Application# '' L 3, ti'-1
CLW
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillinglon,NC 27546 Phone:(910)893-7525 ext2 Fax:(910)893-2793 vn w.hamettorg/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHENSUBMITTING A LAND USE APPLICATION"
LANDOWNER: S »vN
l( QA-latter& Lc Mailing Address: tttJ (4 RcArSr. S4. �
City: h1t(Y/ State: tilt Zip: 3/SU( Contact No: g1973078roa Email: Ctra c� S4tQ nsn .hitl16s.can
APPLICANT': tXow ( I.xutL.-/ Mailing Address: SCLY'rQ LS Acme.
City: State: Zip: Contact No: Email:
*Please fill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: —DC't/v S -rn1 ttera Phone* Rlq Tin 78-01.
ry
PROPERTY LOCATION:Subdivision: 1,1CAtry.1 ?GCM S AC('v:sco.+ Lot#: ILot Size: r71
State Road# ] 53 State Road Name: riot p crx(w- Oc'v t. Map Book 8 Page: 7017 /2-3-1
Parcel: O80bt{I O O51 Di PIN: 0641 - 41 4505 noo
Zoning:1113_3D_Flood Zone:Mi tlWatershed:C* (f Deed Book&Page: / Power Company': duYt cn�v-"i
WS- 1A/
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: ''II
SFD:(Size�/)yax 6S r )a Bedrooms:l #Bama3S5Basement(wMwo bath):_Garage: Deecck:_Crawl Space: ✓_Slab:_Slab:Monoy'
(Is the bonus room finished?( ✓lyes ( )no wl a closet?( )yes ( (if yes add in with#bedrooms)
❑ Mod:(Size x 1#Bedrooms_#Baths_Basement(wAwo bath) Garage: Site Built Deck:_ On Frame_Off Frame_
(Is the second floor finished?( 1 yes L3 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:
❑ Home Occupation:C Rooms: Use: Hours of Operation: *Employees:
❑ Addition/Accessory/Other:(Size x )Use: Closets in addition?( 1 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(5001 of tract listed above?( )yes LEcTEO
Does the property contain any easements whether underground or overhead Oyes ( )no
Structures(existing or proposed):Single family dwellings: 1 y GS Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments: Q1real/ rt.ii .Ora/ W jhri 7 rs
Front Minimum Actual 70 q19 73b 7E-0a.
Rear 5 D —1'1-«1tCs )
Closest Side ID a
Sidesteel/comer lot �� 7/
Nearest Building
on same lot
Residential Land Use Application Page I of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
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If permits are granted I agree to conform to all ordinances and laws of the State of Nath Carolina regulating such work and the specifications of plans submitted-
I hereby state that foregoing statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false Information is provided.
it
^l `t-d3-18
Sig re mer or Owner's Agent Date
"it Is the ownerlapplicanfs 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 6 months from the Initial date if permits have not been Issued"
Residential Land Use Application Page 2 of 2 03/11
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NAME: r�l^nettu BJ�ideis rex-. APPLICATION it:
•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 1 CONFIRMATION#
Environmental Health New Septic SystemCode 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 1W.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 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 desired system type(s): can be ranked in order of preference,must choose one.
(_} Accepted {_1 Innovative (_ Convei .... (_}Any
(_( Alternative (✓(Other 4 Red goon% i F rL.bY.
The applicant shall notify the local health department u n su. I a 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 (14.NO Does the site contain any Jurisdictional Wetlands?
(_(YES ( ✓f NO Do you plan to have an irtieatimn system now or in the future?
(_}YES ti NO Does or will the building contain any digins?Please explain.
{ }YES I✓I NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
( (YES (✓(NO Is any wastewater going to be generated on the site other than domestic sewage?
(_((YES ( .✓}'NO Is the site subject to approval by any other Public Agency?
(6 YES (_) NO Are there any Easements or Right of Ways on this property?
VITUS ( 1 NO 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 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 Accessible So That
AAA Complete Sid(Evaluation Can Be Performed. 4-,3-i 8
/at 6
DAD j�W/L
PROPERTY OWNS OR WNE L AL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
09109111 ' Application#
t Harnett County Central Permitting
{ POr
Box 85 Oblivion NC 27548
Eric seibri Mow b be reed out 910 893 7525 Fax 910 893 2793 www Smelt argipermea
by whomever pMormm9 work
Must tie owner or honed
contactor Address company Aoohcation for Residential Budding and Trades Permit
rime 8 phone must match
Owners Name 5•Fepl..rt.a.. Ru it Aran -Cy Date II-73•IT
Site Address a 33 cn err carni Delve - Phone '1,14 731) 'Me
Directions to lob site from Lullington tla,y 401 rl Last nrdn .vwef..t -Rhin dr; tr
0`7 I mite -cinan hnepivad air lef4 •
Subdivision (tl Ger 1+ cat rt-. Lot 11
Description of Proposed Work N e la S1,3e Fe- .rnit. l\ avSiere of Bedrooms H
Heated SF .2881 Unheated SF 1550 reagirsdtadiinus Room9 yes Crawl Space Yrs Slab
General ContreUor IMormahon
\arias., gu;ldxSc
s Scar ell 73
19. 0 --/80a
Building Cohtractor s Company Name Telephone
Ilk NI °xi.f1t. SAria Art Plc Y7S01 CLCti& leot.is•.. bJiteers co'
Address J J Email Address
531pb4
License#
)electrical Contractor Information
Desaiption of Work Neuf Ll.....a Service Size ?Cn Amps T-Pole Yes No
Ausa;.a °cow Fleclr:ras Cortin rkar c119 Jo(09- n-101
Electrical Contractor a Company Name Telephone
1793 gopV; it (7.m. Li cu Ivry 177S)(a aide askt iter a rhno.c al—
Address
rAddress Email Address
L. a9s39
License#
Machanica uHVAC Contractor Information
Description of Work rkr w Way..
•` C. 'S ‘are.) era A,4 Cn'.As lwt.-' 9let S4J• 3x53
Mechanical Contractors Company Name Telephone
1539 &Jade Srot....t.... card Hofly Spnly X?S1O ...------
Address
Address Email Address
taGSS
License Jr
plumbing Contractor Information _
Description of Work CaavlcnS PI un-6J•5 and 9Tair #Baths 3.S
New Flo etu i 919 - 557 - 15k`1
Plumbing Contractors Company Name Telephone
-aa9 nck_yLllsparacl co Ia., D75}tr
Address Email Address
ISS90b
License#
Jnsulation Contractor lnfomiatron
.5 licipAs.vts •.1 ti‘clist Qtod.icFt 919 630 W3(s.S-
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 Electneal Plumbing and
Mechanical codes and the Hamett County Zoning Ordinance I state the information on the above
contractors is correct as known to me and that)v sianma 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 current fee schedule
��- `{ 13 18
Signal re I o- orlOfficerta)of Corporation Date
Affidavit for Worker's Compensation NC 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 perjury that the person(s) firm(s)or corporation(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 subcontractora(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 prior
to issuance of the permit and at any time dunng the permitted work from any person firm or corporation
carrying out the work l� _
Company or Name S.\,GpVencrt-r R u a(140. -
SignwlTide_441,-/t—
�,• r Pres �ny Date r{' 13-it
Appointment of Lien Agent: Details-LiensNC Lien Service https://apps.liensnc.com/scr/appointment/details.hemi?entryNomber-8...
DO NOT REMOVE!
,Details: Appointment of Lien Agent Filed on: 04/22/2018
Entry I: 83842B Initially flied by:
stephensonbu II dorsi nc
Designated Lien Agent Project Property Print & Post
Chicago Title Company)LLC Lot I1 Morgan Farm i7 it El
233 Morgan Farm Drive
W:c we/wlie:mecm w..+..rm Lillingron,NC 27546
Address:19W Hugo St.Suite 507/Raleigh,NC 11atett Coumy Ella 'Ea
27601 Contnden:
Phos 88669o-n84 Please cosi this notice on the lob Site.
Fat:913489-5231 Property Type
S.PPBen and Sabmalaacldn:
Ee.R:suOPoolO in.c nmo-...ww:ratw Scan this image with your smart phone to
view this filing.You can Own file a Notice
1-2 Family Dwelling to Lien Agent for this project
Owner information
Date of First Furnishing
neplun and natsscha opalka
233 Morgan Farm Drive
06/01/2018
Liltington, NC 27546
United States
f cal:diew@stcphensonbuilders.com
Pone:919-730-7802
View Comments(0)
Technical Support Hoaiae:(888)690-7384
1 of 1 422/2018,6:38 PM
HARNETT COUNTY CASH RECEIPTS
$$: CUSTOMER RECEIPT ***
Date: 74/23/16 52 ReceiptBROCK Te: pno:rawer:330187
Year Number Amount
2018 50043849
233 MORGAN FARM DR
LILLINGTON, NC 27 BP ENV HEALTH FEES
04 $750.00
HEY TANK
STEPHENSON BUILDERS
fender detail
CK CHECK PAYMEN 1336 $750.60
50.00
Total tendered $750.00
Total payment
Trans date: 4/23/18 Time: 9:32:41
** THANK YOU FOR YOUR PAYMENT **