SET UP/ RECEIPT/ PERMIT Application# ` O 5OV`H`d ( CO
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910-893-7525 Fax 910-893-2793 www.harnett.org/permits
Application for Manufactured Home Set-Up Permit
(Please fill out each part completely)
Part I-Owner Information:
Home Owner Information (To be completed by owner of the manufactured home)
Name: Address:
City: State: Zip: Daytime Phone: ( )
Landowner Information (To be completed by landowner, if different than above)
Name: Address:
City: Slate: Zip: Daytime Phone:( )
Part II-Contractor Information(To be completed by Contractors or Homeowner,if applicable.
Name,address, hone mu t mate!)i forrpation��gqn�lice�nn�se)
A. Set-Up Contractor Company Name: �(10 4&a`�e fIUNw- t Sl+
Phone: 6O-t' 6 (05lP-Address: h' fiefq '3c5-9 S-
City: aAfe,}ICtk1J`e Slate: h,fC Zip: ,g -3?--"c
State Lic# 3s- r� Email:
B. Electrical Contractor Company Name:
Phone: Address:
City: State: Zip:
State Lic#0l, _n--.( _ Email:
C. Mechanical Contractor Company Name:
Phone: Address:
City: State: Zip:
State Lic# (]L..01\--0--""---- Email:
D. Plumbing Contractor Company Name:
Phone: Address:
City: State: Zip:
State Lic# O Li-_i ( Email:
Part III-Manufactured Home Information
Model Year: Size: X Complete& follow zoning criteria sheet
Park Name: Lot Number:
I hereby certify that I have the authority to apply for this permit, that the application is correct including the contractor
information and have obtained their permission to purchase these permits on their behalf, and that the construction or
installation will conform to the applicable manufactured home set-up requirements, and the Harnett County Zoning
Ordinance. I understand that if any item is incorrect or false information has been provided that this permit could be
revoked. << 1, Q9
al
Signature of Home OwneMMr Agent Date
'Effective July 1,2004,a County Tax Department Moving Permit must be provided before a Set Up Permit will be issued. It is
purchased from the tax office of the county that the home is moved from. If the home is from a dealer, we need proof of year on the
Form 500 and if available, the serial number.
List of inspections and Egress requirements available upon request Progress Energy customers must provide Premise Number.
SETUP 04/11
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HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call: (910) 893-7525 Fax: (910) 893-2793
Application Number 18-50044100 Date 6/04/18
Property Address 270 NUTGRASS RD
PARCEL NUMBER . 12-0556- - -0122- -02-
PIN 0556-13-5193 . 000
Application type description CP MANUFACTURED HOME RA20R/RA20M CRITERI
Subdivision Name DORTHY MCKOY
Property Zoning RES/AGRI DIST - RA-20M
Owner Contractor
DAVIS TABLEAU SUMMERS OWNER
1439 RAYNOR MCLAMB RD
BUNNLEVEL NC 28323
Applicant
DAVIS TABLEAU
1439 RAYNOR MCLAMB RD
BUNNLEVEL NC 28323
(910) 591-9713
--- Structure Information 000 000 14X70 SWMH 3BDR 2 BTH
Flood Zone FLOOD ZONE X
Other struct info # BATHS 2
# BEDROOMS 3 . 00
MOBILE HOME YEAR 1995 . 00
PROPOSED USE SFD
SEPTIC - EXISTING? EXIST
WATER SUPPLY COUNTY
Permit LAND USE PERMIT
Additional desc
Phone Access Code 1245349
Issue Date . . . 6/04/18 Valuation . . . . 0
Expiration Date . 12/01/18
Permit MANFACTURED HOME PERMIT
Additional desc
Phone Access Code . 1245356
Issue Date . . . . 6/04/18 Valuation . . . . 0
Expiration Date . . 6/04/19
Special Notes and Comments
T/S : 05/23/2018 04 : 04 PM LLUCAS ----
270 NUTGRASS RD
401 S - TURN RIGHT ON MCLEAN CHAPEL
CHURCH RD - LEFT ON WIRE RD - RIGHT
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 18-50044100 Date 6/04/18
Special Notes and Comments
ONTO NUTGRASS RD - ABOUT 2 . 5 MILES ON
THE LEFT
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Page 3
Application Number 18-50044100 Date 6/04/18
Property Address 270 NUTGRASS RD
PARCEL NUMBER . 12-0556- - -0122- -02-
PIN 0556-13-5193 . 000
Application description . . CP MANUFACTURED HOME RA20R/RA2OM CRITERI
Subdivision Name DORTHY MCKOY
Property Zoning RES/AGRI DIST - RA-20M
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
Permit type . . . . MANFACTURED HOME PERMIT
10 501 T501 R*MOBILE HOME FOUND. / M. WALL / /_
10 814 A814 ADDRESS CONFIRMATION / /_
20 818 Z818 PZ*ZONING INSPECTION /_/_
30 507 T507 R*MANUFACTURED HOME FINAL /_/_
HARNETT COUNTY CASH RECEIPTS
Hi CUSTOMER RECEIPT rrr
Oper: SHOCK Type, O5 Drawer: :
Date: 6/04/1E 52 Receipt no: 374662
Year Number Amount
2010 5004410A
270 NUTGRASS RD
AUHHLEVEL, NC 28323
Al AG - PERMIT FEES
8175.00
SOH
• TAH DAVIS
Tender detail
CA CASH PAYMENT s175.00
Total tendered $175.08
Total payment 1175.00
Trans date: 6/04118 Time: 16:34:34
rm THANK YOU FOR YOU: PAYMENT as