DOCUMENTS Initial Application Date: 'T Icy I Application# I BSoOLf 3 $is 5
COUNTY OF HARNETT DEMOLITION APPLICATION
108 E. Front Street,t, Lillington, NC 27546 Phone: (910)893-7525 Faaxx:(910))893-2793 www.harnett.org/permits
Land Owner: r�"�P(C' LIG / �1U/'i'. S Mailing Address:2
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City:4r (//47/64 State:k�LZip— Home#: Contact#:
APPLICANT*: / Mailing Address:
City: State: Zip: Home#: Contact#:
*Please fill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: Phone#:
PROPERTY LOCATION: Subdivision: Lot Acreage:•U ($
State Road#LA9-ta?I SState Road Name: lel S4 0�I S
Parcel:A\ u(s (•g O DI S q PIN: C7LQrI0-0 - b :"<S•to\ zoning:12Ae)24noazone: X
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
Structure(s)to be demolished &removed:Single family dwelling Manufactured Home_Other(specdy)
Structures(existing and/or proposed):Single family dwellings Manufactured Homes Omer(specify)
Water Supply: ( )County (_)Existing Well
Sewage Supply: ( )Existing Septic Tank ( )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
ensure 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
rf 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 ordinances and laws of the State of North Carolina regulating such xwk 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 infomlation is provided.
e - /2/0/1 Or 471 ;2y_ PO/(
Ignature of Owner or Owner's Agent Date
"This application expires 6 months from the initial date If no permits have been Issued"
SAPlanning and Inspections FilesIFORMSICP 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 properly 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 complies with the requirements of the NC
State Building C-odes and applicable Harnett County Ordinances.Call for inspection at proper stage of work. --
CONTRACTOR/APPLICANT DATE LICENSE NO. (If applicable)
Please contact the Department of Health and Human Services for their requirements and permit information.
http://unewspi.state.nc.uslepi/asbestos/ahmp.html
S:Planning and Inspections Flies\FORMS\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 18-50043865 Date 4/24/18
Property Address 20 GREENS CHAPEL CHURCH RD
PARCEL NUMBER 11-0660- - -0159- - -
Application type description CP DEMOLITION RESIDENTIAL
Subdivision Name
Property Zoning RES/AGRI DIST - RA-20M
Owner Contractor
MORRIS ETHEARL OWNER
PO BOX 629
BUIES CREEK NC 27506
(910) 893-6932
Applicant
MORRIS ETHEARL
PO BOX 1832
LILLINGTON NC 27546
--- Structure Information 000 000 DEMO SWMH
Other struct info PROPOSED USE DEMO SWMH
Permit RESIDENTIAL DEMOLITION PERMIT
Additional desc
Phone Access Code 1239771
Issue Date . 4/24/18 Valuation . . . 0
Expiration Date . 4/24/19
Special Notes and Comments
GREENS CHAPEL CHURCH RD
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 18-50043865 Date 4/24/18
Property Address 20 GREENS CHAPEL CHURCH RD
PARCEL NUMBER 11-0660- - -0159- - -
Application description . . CP DEMOLITION RESIDENTIAL
Subdivision Name
Property Zoning RES/AGRI DIST - RA-20M
Permit RESIDENTIAL DEMOLITION PERMIT
Additional desc .
Phone Access Code . 1239771
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 wwa
Goer: JDROCK Type: CP Drawer: '
Date: 4/24/18 52 Receipt no: 331557
Year Number Amount
2818 58843865
28 GREENS CHAPEL CHURCH RD
FUOUAY-VARINAT HC 27526
81 6w' - PERMIT FEES
475.08
DEMO PERMIT
ETHEAHL MORRIS
Tender detail
CA CASH PAYMENT 4188.88
Total tendered 4188.00
Total payment 475.08
Change 425.00
Trans date: 4/24/18 Tine: 15:43:58
** THANK YOU FOR YOUR PAYMENT an