DOCUMENTS Initial Application Date: IPJ I I D f. {3%4'1 Application# '��-+e— 1 t �0
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- . • n ION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.hamettorglpermils
^A RECORDED SURVEY MAP,RECORDED!� DEED(OR OFFER TO PURCHASE)&SITE PLAN ME REQUIRED WHEN SUBMITTINGUBA LAND USE APPUCAIION^
LANDOWNER: �'IAVP "1 M4 nd..er x Mailing Address: q3 (D Wa'urYl1 14J (�
City: ..ru,,70( tk. 1 MState�r( Tipa1239 Contact Ngo:x1 1^,,Z2/'1�I- (�l�1r,(Email:l(r(� �A tch'!S ( p0
APPLICANT': �F/EK P�S M1CJL_L.1L Mailing Address: 2300 c(c yl1X'Tc 1- I ���"""lll FsC°.
City: Staley V, Zip _Contact No: �I-I OLP7�t ,/ Email: -et Q�QS(Y'.Cf/TT\
'Please fill out applicant information if different than landownernI ���l� Q p. �(�"� �]
CONTACT NAME APPLYING IN OFFICE: ( a-er 1 .-Quer
Phone ft l l rail 1 'r7
•
PROPERTY LOCATION:Subdivision: \/'� (�.p'n n I/VI Lot#: a-- Lot Size:izz`r'-�a-S
State Road#1 _1',-..gto �Staate Road Name:Na � 1Ct r` " \ 2T J -4;94°1-.0
Book 8 Page: /T J r s
Parcel' t ,D 0 4(-d, O3 11 Q.i Q PIN: D get( Q ' cr.) —094�`0w
Zoning v.'t cod Zone: /0 Watershed: N Deed Book S Pe9eata-0 /4 32—Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Size x )it Bedrooms:_#Baths:_Basement(w/wo bath):_Garage:_Deck: Crawl Space:_Slab:_Slab:_
(Is the bonus room finished?(_)yes (_)no w/a closet?( )yes (_)no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms_#Baths_Basement(w/w°bath)_Garage:_Site Built Deck:_ On Frame_Off Frame_
(Is the second floor finished?( I yes (_)no Any other site built additions?(_)yes (_)no
❑ Manufactured Home: SW_DW TW(Size x )#Bedrooms: Garage: (site built?_)Deck: (site built? )
❑ Duplex:(Size s )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: 11 Use: Hours
s of Operation: c)(2.1
((Employees:
is
iAddition/Accessory/Other.(Size l e x LI 0)Use: t t 031C/LI A 2 \[.()( M(N t� l RZ/ Closets in addition?( )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) 'isting Septic Tank(Complete Checklist) _County Sewer
Does owner of this tract of land,own land that contains a manufactured home within live hundred feet(500')of tract listed above?( )yes Imo
Does the property contain any easements whether underground or ovedhea 4 I yes (� o
Structures(existing or proposed):Single family dwellings: Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum Actual
Rear lU d -
Closest Side
Sidestreeucomer lot
Nearest Building CI
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
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SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
VA +0 7. PA!`_K e.tl\ sl y Pry 'Tjlgn 'RztOe(r-c (4A
Al ► • fw Alt_ e va ad•.si a .•
--n L.9c cee •
ne
If permits are granted gree to confo 7 the State of North Carolina regulating such work end the specifications of plans submitted.
I hereby state that fo -••he'stelemen ' . . :p•..n o • T r • ledge. Permit subject to revocation if false information Is provided.
/Phi It (Lme S a01 %
signature of Ow- - ner's Agent Date
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••'h Is the owner/applicants responsibility to provide the county with any applicable information about the subject property,including but not limited
to:bdundary information,house Iocatlon;underground or overhead easements,etc.The county or itstenployees 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: 000 ( 9( S OC.-- LLC APPLICATION#:
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*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#
Environmental Health New Septic SvstemCode 800
• All properly 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 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 lid,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 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.
I—) Accepted L) Innovative ( ) Conventional (_} Any
{_} Alternative (_) Other
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:
I )YES ( I NO Does the site contain any Jurisdictional Wetlands?
(_)YES {_I NO Do you plan to have an irritation system now or in the future?
( }YES { } NO Does or will the building contain any drains?Please explain.
I—IVES 1—I NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
( IYES { ) 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?
{ }YES { )NO Are there any Easements or Right of Ways on this property?
(_}YES I_}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 Applicatio .n. Certify That The Information Provided Herein Is True,Complete And Correct. Authorized County And
S • e Officials - Granted . ,lit 0 Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
th
I .•rstand T t I A q... es,,nsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
Sit ere . So . aluation Can Be Performed.
PROPERTY OWNERS ONERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) 345 fOI�
R�WDATE
10/10
/6- -0.2.3 -8-Ar
Town of Erwin
Permit#
Fire Zoning Application & Permit
Planning & Inspections Department
Rev Sep2010
Each application should be submitted with an attached plot/site plan with the proposed use/structure showing lot
shape,existing and proposed buildings,parking and loading areas,access drives and front,rear,and side yard
dimensions. q U /z (
Name of Applicant C ( Pc arc 1St ` Property Owner K—P 'P� ne{�r
/Wp
Home Address Home Address II b et rr'f ek RC
City,State,Zip City,State,Zip itict, ( n
Telephone Telephone`/nay', Q( 17 - 77 � — t01p
�/
Email
se( c`Q0I cISvle.fwa Email
Address of Proposed Property /3L'' L ./U//e, CO
Parcel Identification Number(s)(PIN) O _ y7_ &3qa Estimated Projectp\JJ
What is the applicant requesting to build/what is I 1 &O.-a/
the proposed use of the subject property? Ile specific. YI - 5 `y��J4 '�� I ,1Description of any proposed improvementsJUPI 2 5 208
to the building or property 1
What was the Previous Use of the subject property? (Xw / ^ 5/T6W?�f�l' ERWIN
Does the Property Access DOT road? (/e ) 1 11 •, rs 1 Ll`
Number of dwelling/structures on the property already / a Property/Parcel/ size _ 215--- ar/5
Floodplain SFHA YesxNo Watershed Yes>e No Wetlands Yes X No
MUST circle one that applies to property Existing/Proposed Sstem Or
Existing/Proposed County/City Sewer
Owner/Applicant Must Read and Sign
The undersigned property owner,or duly authorized agent/representative thereof certifies that this application and the forgoing
answers,statements,and other information herewith submitted are in all respects true and correct to the best of their knowledge
and belief. The undersigning party understands that any incorrect information submitted may result in the revocation of this
application. Upon issuance of this permit,the undersi. •' rty agrees to c• to all applicable town ordinances,zoning
regulations,and the laws of the State of North Car na regulati : such wor . the specifications of plans herein submitted.
The undersigning party authorizes the Town of Er . to review 1:is r I ues duct a site inspection to ensure compliance
tot '' application as ap'roved. —
a5
,r ,, aolg
Prin Name Signature fOwner. ' .resenllt
For Office Use
, Zoning District f(—10 Existing Nonconforming Uses or Features
Front Yard Setback Other Permits Required _Conditional Use _Building _Fire Marshal XOther
3 5—I
Requires Town Zoning Inspecti n(s) I _F _ to C.of O.Side Yard Setback
f Zoning Permiti Status Approved Denied
Prim.
Rear Yard Setback n25-- Fee Paid: /� I Date Paid:IF�0IS/iVoundation I Staff lnitials�
Comments
\'
gSignature of Town Representative: , �(.` ' ,roved/Denied: [
Y Jot G7015//21
/DI ( 4)1 5/)C C ( /a , (/7 /, oC�
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09/09(11 Application#
Harnett County Central Permitting
PO Box 85 UIkngton NC 27548
Each secaon below to be Nled out 910 893 7525 Fax 910 893 2793 www hermit org/pemide
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name 8 phone must match (� (� 'l t2
(Tuners Name SVA Cj\c.-e. Pal In ry`Pr Date CrCQS— 6
Site Address 2 6: • • • Phone9tO - 22.9- (oQ-j J
Dctions to job site .,W _ _from Lillington .e . Ill\ 1\).e 1r + ,LP + ^
I eC f01
ITS �.� L n n .e e rco ,r1 t. - 0 , �tl(-r
O Ali -knrin C.Innr 4o Oaf.79A
Subdivision Lot
P
Descripaon of Proposed Work I IN(n 'CILA U. Poo #of Bedrooms
Heated SF Unheated SF J Finished Bonus Room, Crawl Space _Slab
General Contractor Information
cool eh q4 asci �c01-1a7—)
Building Contractors ompany Name g, �, Telephone /\
a300 nkri (1C 1 uj "T�"-� 0 ('t:r(e9i On l eors�spl�i .Cyr
Address I Em'ai Address
STY.)l Co
License#
Electrical Contractor Informattoq
Description of W Service Size Amps T-Pole _Yes_No
Pn _
r r , , Tfnr- girt -Sg5C-S .-60
Electncal Contractors Company Name _ II Telephone
`P n . Sg3SS 12�0i csk uC C . E ucckm.v e(carf (Qrcet2c htc
sek SIvS — L. ail Address
Com.
License#
MIlechanicallHVAC Contractor Information
Description of Work
Mechanical Contractors Company Name Telephone
Address Email Address
License#
plumbma Contractor Information
Description of Work #Baths
Plumbing Contractors Company Name Telephone
Address Email Address
License#
Insulation Contractor Information
Insulation Contractors Company Name a 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 Harnett County Zoning Ordinance I state the information on the above
contractors is correct as known to me and that pv manna below I have obtained all subcontractors
permission to obtain these permits and if mg changes occur including listed contractors site plan
number of bedrooms building and trade plans Environmental Health permit changes or proposed use
changes ••rtify it is my respo•- • lity to nobly the Harnett County Central Permitting Department of
any as allch- ges
EX• •ED PER IT FEE' -e •nths o 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is :5 .• curveI s 44/
! .• ,-e a5 30iS,
Signa • • -r/ on - -icer(s)of Corporation Date
Affidavit for Worker's Compensation NC G S 87-14
T`he u erstgned 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 fo 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
covenng themselves
Has no more than two(2)employees and no subcontractors
While working on the project for which this permit is sought rt 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 an ••_ dunng the permitted work from any person firm or corporation
carrying out the work
(l
Company or Name l ' ( •� f C
Sign wRNe CS-141n Y \ r _ 1�.P Date �(.f n_'P 7-Sr Z-0 0
Application#
Harnett County Central Permitting
PO Box 65 Lillington,NC 27546 - Ph:910-693-7525 - Fx:910-893-2793 - www.hamett.org/permits
Certification of Work Performed By Owner/Contractor
(Individual Trade
Trade Application) Q q
Owner(s)of Structure: r,1Cite, Pal r.A-er /ad)
` 10
3�
Owner(s) Mailing Address: 1 ct, (1")4.1 r C f\ _ Rd) .
Frc 5iA
Land Owner Name(s): ?-•Ac V-e Pru v l-er c Phone: q 1 O — 72A — (-Oct 7 I
Construction or Site Address: e
PIN# Parcel#
Job Cost: Ia OD .w Description of Work to be done ti le L P ..
LTD
I. kk ()ThdnCti(,JS 614 Ai P. r .
Mechanical: New Unit With Ductwork_ New Unit Without Ductwork_ Gas Piping_Other_
Electrical': 200 Amp_<200 Amp_Service Change_ Service Reconnect_ Other
*For Progress Energy customers we need the premise number
Plumbing: Water/Sewer Tap Number of Baths Water Heater
Secfic Directions to Job from Lillin tan: 2 I ej_
o\nc lar �4-• 2oss � p cF , kw Tt�Gn o s p�p Ledl
kt' Wert t.. •
Subdivision: Lot#:
•
IV( `n,,_ _ -- I � '/�1
I Pc C Cir / 1 L 1/C will provide the �QCIkfl CDS\ labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is act 5 ,which entitles me to
perform such work on the above structure legally. All work shall comply with the State Building Code and all
other applicable State and local laws,ordinances and regulations.
(c1 - 5co
Contractor's Company Name Telephone
2.0 i&jc 5?-3c5.24.4,2,4tio. 0udrom.eecare.Qarceltc4-n&
Address / Email Address
License# \ ^ �`
Structure Owner/Contractor Signatu Date: c�U ne 2C�,ao v t/
By signing this application you affirm that you have obtained permission from the above listed license holder to
purchase permits on their behalf. If doing the work as owner you understand that you cannot rent lease or sell
the listed property for 12 months after completion of the listed work.
*Company name, address, 8 phone must match information on license
HARNETT COUNTY CASH RECEIPTS
4** CUSTOMER RECEIPT ***
Oper: JBROCK Tyne: CP Drawer: 1
Date: 6/25/18 52 Receipt no: 401013
Year Hunter Amount
2618 58044548
91749 TECH 2
LILLINGTON, HC 27546
B1 BP - PERMIT EEE2
41BB.a0
EXT TANN
COOL POOLS
Tender detail
CP CREDIT CARD 4/00.00
Total tendered 4tat.BO
Total payment 4100.80
Trans date: 6/25/18 Time: 15:49:09
** THAHN YOU FOR YOUR PAYMENT **