DOCUMENTS Mai Application Date: Cr -1% Application it I ?5(D( —ll a
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COUNTY OF HAPSET'RESIDENTIAL LAND USE APPUCATION
Cenral Permitting 108 E.Front Street,Langton,NC 27548 Phone:(910)893-7525 ext2 Fax:(910)893-2793 www.hametl.orglpennits
^A MGM, O SUIRVEY MAP,RECORDED DEED(OR FER TO PURCHASE)&SITE RAN ARE REQUIREDWHENsuntan-ow A LAND USE APPLICATION'
11th �Cl.]S't'f .rSlY�
LANDOWNER:, cx., cSr? , �.�rs Mailing Address: it S 7 1V Rr Veit., d4
City �LSt-er State:144. Zip: 27%)1 Contact No: gib 736 76-0a. Email: &EMG s'+TQbasesht2cs.con
APPLICANT:: btribrcS1091.4
Nem/ Mailing Address: 54t4 C3 nbf.
City: State:_Zp: Contact No: Email:
'Tease fill out applicant irmeretion if different than landowner
CONTACT NAME APPLYING IN OFFICE: SaTiebenteta Phone* Q(Q 73T 7p..a.r1
)1)
PROPERTY LOCATION:IlSubdivision:_ I^s � -- 1;243T
_ 1 [ ri\r[x� Lot*: Lot
tsSize:a r�A'S
State Road* Tyra State Road Name: PI-stS 1P 1 KQ,d Map Book&Page:7)O I S / (04I
Parcel: 6SO (0Z3 n.Y1g n1 PIN: n 1 1.7 Oto81 . FY)
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zoning:Q(1 ?2 Flood Zone: Mini Watershed:Lib-1i/ Dead Bode&Page:-ZSK(a I AnQ4{ Power Company': C(Ulfp Prer37
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: a cU11 tCw
Monolithic
M' SFD:(Size ply x (trrOO 7 )#Bedrooms:**Baths: nt(whvo bath): Garage:Y"Deck:a Crawl Space:Y Slab:_Slab:_
(Is the bonus room finished? Yes ( )no w/a closet?( )yes t- f no(if yes add in with*bedrooms)
❑ Mod:(Size x )S Bedrooms *Baths Basement(w/wo bath) Garage:_Site Built Deck_ On Frame ON Frame_
(Is the second floor finished?L_J yes U no Any other site butt additions?( )yes (J no
❑ Manufactured Home: SW_DW_TW(Size x )*Bedrooms:_Garage: (site built? 1 Deck: (site built?
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit
❑ Home Occupation:if Rooms: Use: Hours of Operation: *EmWdyees:
❑ Addition/Accessory/Other:(See_x_)Use: Closets in addition?( )yes ( )no
Water Supply: IV-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 Check*sO County Sewer
Does owner of this bad of land,own land that contains a manufactured home within five hundred feet(500')of trad listed above?( )yes ryp�ry
Does the property contain any easements whether underground or overhead Oyes ( )no
Structures(existing or proposed):Single family dwellings: y a Manufactured Homes: `` Other(spedfy):
Required Residential Property Line Setbacks: COMMIS: PI rCt Sr rr.I) 1Crt.-/ �]'1alrtnl
Front Minimum �S` Actual I73 ( nInpct ?LiSk"rb.S 1"
Rear 7 l-0 /0 73o 760)-
Closest Side 10 W(9
Sidestree9cornerlot Z0
Nearest BulMalg
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM U W NGTON:
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If permits me granted I agree to conform to all ordinances and laws of the State of Nord Caroline regulating such work and the specifications of plans submitted.
I hereby state that foregoing statements me accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
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Sgn�ure r«OwraraAgnl DN
mit Is the ownedeppll ants respo I/nsibllityvto provide the county with any applicable Information about the subject property,Including but not limited
to:boundary information,Nouse 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 d months from the Initial date N permits have not been issuer
•
Residential Land Use Application Page 2 of 2 03/11
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SITE PLAN APPROVAL
asrRICT - c— Lille Is aejocJ p6Ate Corners
SE
nEOROOMS ' 6CGje ;Ir_ 50-c+
NAME:Soitcnnese $dr-(dwJ r-n-. APPLICATION B:
'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 I CONFIRMATION N
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 comers.
• 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 aftfor 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 undergrowth to allow the soil
evaluation to be performed. Inspectors should be able to walk freely around site. Do not grade properly.
• All lots to be addressed within 10 business days after confirmation.$25.00 return trip fee may be incurred
for failure to uncover outlet lid.mark house corners and prevent'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 recordino for proof of request,-,
• Use Click2Gov or IVR to verity results. Once approved,proceed to Central Permitting for permits.
Environmental Health Ezisilno 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.
• 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 {✓(Conventional {_)Any nn .—�
(_1 Alternative { )_ Other _ - " - e e P�cc'C i2430- s; a F 1'a�Yati }
(JoSs$0
The applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in
question.•If the answer is"yes",applicant MUST ATTACH SUPPORTING DOCUMENTATION:
{_IVES (✓) NO Does the site contain any Jurisdictional Wetlands? •
{_)YES (xi NO Do you plan to have an irrieation system now or in the future?
(_)YES (.v) NO Does or will the building contain any d[aina?Please explain.
( }YES (sG)NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
(_}YES f✓}'NO Is any wastewater going to be generated on the site other than domestic sewage?
(_))YES ( ✓F NO Is the site subject to approval by any other Public Agency?
(V,YES { } NO Are there any Easements or Right of Ways on this property?
6/1YES t_) NO Does the site contain any existing water,cable,phone or underground electric lines?
If yes please call No Cuts at 800-632-4949 to locate the lines. This is a free service.
I Have Read This Application And Certify That The Infornrtion Provided Herein Is True,Complete And Correct Authorized County And
State Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I Understand That I Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site Accessible So That A Complete Si Evaluation Can Be Performed.
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PROPERTY OWNERS OR O' L$AL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
09109/11 Application#
Harnett County Central PennMing
PO Box 85 Lininglon NC 27548
Each section below to be Idled out 910 893 7525 Fax 910 893 2793 www hornet org/permde
by whomever performingwork
Must be opener or licensed
aaibaclor Address company Application for Residential Budding and Trades Perms(
name 8 phone must match
Owners Name Skedwmil,. Rd II his tint Date (a - I- 18
Site Address %a Ad3le-' ROGLI , coque./ VacaPS 3-7v42 Phone 4L9 Ino 7Koa-
Directions to job site fmen Llllmfrion "' \ J
—�0•Ve c> "... 1 t(-i (L(M,n. LCkt nW ( Ve,},J1 air Ps t1 c(< CM* PGA, et.lLefi •
Subdivision _ . Pl\ar.\e 1 ravel. Lot Pcleolp -F-1
Description of Proposed Work Ne tu 5:"b1. Gamin Fume #of Bedrooms
Heated SF,10413 Unheated SF Inn Finished Bonus Room/ Yes Crawl Space Yes Slab
General Contractor Information
%0 a ccsa Qtd;lder! 'Sinn - 1119-13t) 7190
Building Cohtractor s Company Name Telephone
11K] M ae.1 s1. A. e, NC »sol eirtwol7<�ee1....... W;Iders._c_041
Address Email ress
Sabby
License#
Electrical Contractor Information
Descripton of Work I4e,.i claw.e Service Size XI) Amps T-Pole ✓Yes_No
ikA-Is i ()caw Flabfir.i ru&r.t*wr cl19.4G9- n- i
Electrical Contractors Company Name Telephone
1.79-1 8op�:s1 [ode Q-et. Curl 7'7S}to akirarOf310r]Yc.Me.rer--
Address Email Address
L 99839
License#
Mechanical/HVAC Contractor Informato0
Description of Work Kew We,yx.a
-S .C. 's FIeeS t r+...a A.4 CorA\L+y..- 919 553• 3b53
Mechanical Contractors Cbmpany Name Telephone
1539 Wade Sk�t...�n,.w good folly s- s1sro l
Address Email Address
IaGSs
License#
Plumbing Contractor Information ,1 ./
Descriptio of Work Carvlcris Pl�rr•F,a Ond (!chair #Baths at) Ja MxtF
fVar 1-tnrrV 919 - SS? - 1 51i`f
Plumbing Contractors Company Name Telephone
-7729MKVtIrthao.j Clu.1 a75)-t• -�
Address Email Address
1e90'
License#
Insulation Contractor Information
SNESey.1 €. \ddYj ()redwcts 419 430 F3&p
Insulati n 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 Electrical 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 pv sianma below I have obtained all subcontractors
permission to obtain these permits and if jr v 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 Hamett County Central Permitting Department of
any and all changes
EXPIRED PERMIT FEES-S Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is as per current fee schedule
Signatlreo�wnat trio or/Officer(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 confirm under penalties of perjury that the person(s) finn(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 itis understood that the Central Pennming
Department issuing the permit may require certificates of coverage of workers compensation insurance pnor
to issuance of the permit and at any time dunng the permitted work from any person firm or corporation
carrying out the work
Company or Name <'cAccikntrty V GAS T-rf
Sign w/Tida r '� er. Date(- 1 ' (S
Appointment of Lim Agent Details-LimsNC Lim Service hups:i/Q s.lie0mc coin sa/appommmNdeldb.htm17e00yNUmbn \
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed Ca: 05/28/2010
Entry P: $59904 SOWN filed by:
etepbensanbulldersinc
Desi len Agent Project Property Print & Post
Clime Tele Company,LLC Prise Land Lott'
160 Arley Rood •
Yierssl'stcmrrrr.l NOsy-vagTIC 27326
Sem 19V.wYlea.L's F/1R S..IC nil C00017
3701 Catmint
tie rm66677m Plisse pants mace m de lab Sc
r ,913- ml Propertg Type
Sowelensei
vt S®*idm Seb impwitya mpima/
. . - vh7vni Dai Yes tin file•Notice
. . I.2 Prayer - ss Lien Aims d project
Owner Information
Date of First Faralshing
-. bit . .
1137 North Rakish Skeet • 07R1/201d
Aapa,NC 27301
USW Sales
Emit diese.Ymms ssideacm
Pham 919-730.7102
Kew Ca®m(0)
2briniral Semen Hagen(131)690.7314
1 of 5282018, 11:10 AM
HARNETT COUNTY CASH RECEIPTS
*** CUSTOMER RECEIPT ***
Uper: JBROCK Tyne: SUP Drawer: 1
Date: 6/04/1& 52 Receipt no: 374633
Year Number Amount
2018 50044166
95138 *UNASSIGNED
FUWUAY-VARINA. NC 27526
B4 PP - ENV HEALTH FEES
NEW TANK 6750.00
STEPHENSON BUILDERS
Tender detail
CK CHECK PAYMEN 1423 475a.80
total tendered $750.00
Total payment £750.08
Trans date: 6/04/18 Trme: 18:13:36
** THANK YOU FOR YOUR PAYMENT **