DOCUMENTS Initial Application Date: 6"a3- 1 O Application* I 3501(244°C4/7
Cur
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street UNngton,NC 275/6 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 vnAw hamett.org/pemrits
^A RECORDED SURVEY LMP,RECORDED DEED(OR OFFER TO PURCNASE)8 SITE PLAN ARE REQUIRED WHENSUBMITTING A LAND USE APPLICATION"
LANDOWNER: .54C.- esfie-I Q. 1l4& Twe Mailing Address: II t 7 N QL,[t �. S4•
City: Ayy5t-we State:nk Zip: 37401 Contact No: 9197QO7d'Od Email: &CWr1. S- 1•FMeeibilks em
APPLICANT': Theme . 4.syEwa Melting Address: $4VM4 GS 140MY
City: State: Zip: Contact No: Email:
*Please fill out appeals!ill.onrelian ii different than landowner LTi ..r�
CONTACT NAME APPLYING IN OFFICE:l-n t i SZCq.+rnrMA Phone* (lig • UA 7D"
PROPERTY LOCATION:SIAdNoian: I•wrsd4 Ca(M Su td 11ri YT..e Lott. 13 Lot Size: •go CU yes
State Road* d-3o State Road Nacre: CIF\ 50'N C4c'r nf)A/C Map Book 8 Page: 001 / 7)-
Parcel: �RO )D (a' 06 .5-‘ ...2-CO PIN: A lig\ - 32- ^iby 8 • DuD
Zoning: (�'fW Flood Zone:c \N Watershed: VS-1V Deed Book&Page: 3((O0 / Ot(ra Power Company':j41)P PIMryy
*New structures with Progress Energy as service provider need to supply premise number V- 401a as (0 a� from Progress Energy.
PROPOSED USE:
�l _ Sl
Monolithic
Er SFD (i
(Size 7 x _)*Bedmorm:1S Baths:3'SBay1efp(wAvo bath):_Garage:VDeck: Space:Crawl Spa : Slab:_ ab:_
(Is the burros room finished?( Yes ( )no w/a closet?(J,Qyes Li no Of yes add in with*bedrooms)
❑ Mod:(Size_fir )SBedrooms *Baths_Basement(who bath) Garage: Site BuIN Deck: On Frame_Off Frame_
(Is the second floor finished?Li yes U no My other site built additions?( 1 yes Li no
❑ Manufactured Home: SW_DW_TW(Size_x )A Bedrooms: Garage: (site built? )Deck: (site built? 1
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:*Rooms: Use: Flows of Operation: *Employees:
❑ AddPoo&Accesso /Other:(Size_x. 1 Use: Closets in addition?Li yes ( )no
Water Supply: County Existing Well _New Well(Z of dwellings using we* )'Must have operable water beton final
I
Sewage Supply: V/New Septic Tank(Complete Checklist Existing Septic Tart(Complete Checklist) _County Sewer
Does owner of this tract of land,own land that contains a manufactured home within five hundred feet(505)of tract listed above?(__)yes no
Does the property contain any easements whether underground or ovedwad( ryes LD no
Structures(existing or proposed):Single family dnelings: 1 y[S Manufactured Howes: Other(specify):
Required Residential Property Line Setbacks: Comments: O q1l- -Drlw/ i 19 �7 n --1K-0D a..
front Minimum35l`I V
Actual 3(D Ow .' rlVS'S\11'W[
1
Rear 7 X14 )
Closest Side 1 4
Sidestree9corner lot .20
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPUCATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM UW NGTON:
14.1 1(01 t4. AtmroJt 1 O. c rtr \iwsQCCv i•
4-a\<0 \ cf-t 6,4t, omit-sore Cie,. ntl..t
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 cared to the best of my knowledge. Permit subject to revocation if false information is provided.
/ 8
Sig m •,. ror Owner's Agent Date
—It is the ownedappllcants responsibility to provide the county with any applicable Information about the subject property,Including but not limited
to:boundary hnonnatlon,house location,underground or overhead easements,etc.The county or Its employees are not responsible for any
Incorrect or mbxing information that Is contained within these applicauora m
"This application expires 6 months from the Initial date N permits have not been Issued"
•
Residential Land Use Application Page 2 of 2 03/11
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SITE PLAN APPROVAL
DISTRICT USES
#BEDROOMS airiL
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Date
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.NAME! S cMnxu &flay ] y. APPLICATION Ii:
1
*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 FAISIFB9,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$eotlo 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 property is thickly wooded, Environmental Health requires that you clean out the underarowth 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 trio fee may be incurred
for failure to uncover outlet lid,mark house comers and property lines,etc. once lot confined 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 0iven at end of recordina 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 UDS OFF OF SEPTIC TANK
• Atter 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 recordina 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 (_)Innovative (r1"Conventioml (_j Any
4 PSCC\ t7norn St P\zx Ate^ scop 11 h caC
I-1 Alternative [_I Other vr,.{o.rt a `) het Q
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 {✓NO Does the site contain any Jurisdictional Wetlands?
(_)YES { ✓(NO Do you plan to have an ition system now or in the future?
(_)YES {w-1 NO Does or will the building contain any drains?Please explain.
!_}YES (/!NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
{_}YES (...I-NO Is any wastewater going to be generated on the site other than domestic sewage?
{_}}YES { ✓F NO Is the site subject to approval by any other Public Agency?
(V LYES {_} NO Are there any Easements or Right of Ways on this property?
(✓I YES (_)NO Does the site contain any existing water,cable,phone or underground electric lines?
If yes please call No Cuts at 800-6324949 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 MI Property Lines And Corners And Making
The Site Accessible So That A Complete Si -Evaluation Can Be Performed.
A, .-.__L 523' ! 8
PROPERTY 0 ' ' OR a ' T L r AL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
09109111 Application#
Harnett County Central Permitting
PO Box 65 Langton NC 27546
Each section below to be filled out 910 693 7525 Fax 910 893 2793 www hemett ors/permits
by whomever Patpmm9 work
Must be owner or licensed
contractor Address canpany Application for Residential Budding and Trades Permit
name&phone must match
Owners Name 5-Feewnx.. g0ilAtvs -Qv- Date 5-a3-IFl
Site Address 30 Mort Ca dm Daft Lilhiw5\oer a-754i. Phone 41Q '7'y17 gbh
Directions to lob site from Ldlington &1.,y 401 rd. LeM- n rcln .vWJ..r -f'crnn .-u ; rr
D I milt -c n.v. 9wnscr; L dkr teft- •
Subdivision Met GApr Four. Lot 13
Description of Proposed Work tie w 5 tp Fyrnity 14et~ #of Bedrooms L{
Heated SF a9o0 Unheated SF 300 Finished Bonus Room/ `KKS Crawl Space 1'cs Slab
General Contractor Infonnatiou
4l 9• ;110a
Building Co tractor s Company Name Telephone
1\4� wl (lrlet l Si. Nc D7SO I C1 tee..0 b.-Cider-3 r avrt
Address Ur Email
53(vby
License#
Electrical Contractor Information
Description of Work tint Lien.e Service Size ?die Amps T-Pole ryes_No
Ankh Otani Fivr-U...5 Conirohror C119 .449- mit
Electrical Contractors Company Name Telephone
119.1 Beet- s Gist. P-d. COrevci 7'7S}40 akdraPei 330r]ye.}v,0.ra•—
Address Email Address
L x9839
License#
Mschanical/14VAC Contractor Information
Description of Work Mev \1a sv.a
.C. .3 41.1:1. ,And A.tr ConA.A�a w) 9I9 533' 3t53
Mechanical Contractor s C6mpany Name Telephone
1539 Licrdr Nunir. Qdod 14etly Sets 31510 l
Address Email Address
IGSS
License#
plumbina Contractor Information
Descripbo2 of Work Cairwcns PIr7yrbY ow 9101r #Baths 3:5
Nn. Hcyrte IL 914 . 557 - 15E01
1
Plumbing Contractors Company Name Telephone
�n4
ne u Urajeski Clue1 ais}t.
Address Email Address
lif902,
License#
Insulation Contractor Information
icl.tns g9�\c4va Qcadrtels 919 430 R362.5--
Insulation Contractors Company Name Si Address Telephone
*NOTE General Contractor must fill out and sign the second page of this application
c' 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 by sianma below I have obtained all subcontractors
permission to obtain these mimes and if my 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-5 Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is as per current fee schedule
v
5-a3 -1 £S
Signa taLosN,1pOwnerl� or/Ofiicer(s)of Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The undersigned applicant being the
General Contractor Owner _Officer/Agent of the Contractor or Owner
Do hereby confirmunder penalties of pequry 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 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 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 pnor
to issuance of the permit and at any time during the permitted work from any person tem or corporation
carrying out the work
Company or Name <S Eevtvfwr 4 v it elite •
-
sign w/Title ( r f n�. Date C-a3-I
Appointment of Lien Agent:Details-LiensNC Lien Service https://apps,liensnc.com/scr/appointment/details,html?entryNmnber-8..,
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 05/22/2018
Entry #: 856566 Initially filed by:
stephen son bull dersl nc
Designated Lien Agent Protect Property Print & Post
Chicago Title Company,LLC Lot 13 Morgan Farm 1:11 -E!l
230 Morgan Fann Drive
neaee:w+:w.lien ccomaii:... Lillingluq NC 27546
Address:19W.Hewett St,Suite 507 l Raleigh NC hence County O ua
27601
Contneron:
Plat 8aB490-73S4 Please post this notice on the Job Site.
Fa.:913489-5231 Property Type
Sappnen and Suhrontncton:
Email:e.aaun(aierencSan this image with your smart phone to
Dew this filing.You can then file a Notice
1-2 Family Dwelling to Lien Agent For this project
Owner Information
Date of First Furnishing
stephenson builders inc
1187 North Raleigh Shat
07/01/2018
Angler, NC 27501
United States
Email.drew®ucphensonbuilders'.com
Phone'.919-730-7802
View Comments(0)
Technical Support Hotline:(888)690-7384
I of 1 5/22/2018,6:41 PM
HARNETT COUNTY CAS: nt:ric:5
*** CUSTOMER RECEIPT ***
Oper: JBROCK Type: CP Drawer: 1
Date: 5/23/18 52 Receipt no: 365662
Year Number Amsunt
2218 50044097
91749 TECH 2
LILLINOTON, NC 27546
84 BF' - ENV HEALTH FEES
*752.00
NEW TANK
STEPHENSON BUILDERS
lender detail
CK CHECK PAYMEN 1400 *750.00
Total tendered 4752.00
Total payment 1752.00
Trans date: 5/23/16 Time: 13:15:05
** THANK YOU FOR YOUR PAYMENT **