DOCUMENTS R Initial Application Date: I gn90 LII � N N Application# I ?sOG t f 313 6
cu#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)8932793 www.hamett.org/permits
"ARECORDED SURVEY MAP,RECORDED DEED OR OFFER TO P (CHASE)&SITE PLAN ARE REQUIRED WHE BMITTING A LAND USE ,PPLICATI r N"
EC
LAND WNER: V It . • the I I `'i'.. Address: �/�f y111��2 L A Iya .. G�.c �-
City: Ai-Lc 11 //r State: r Zip:d ,V Nmtact No: `ob-263- T-263 I n)ha{a•- I r. 0' '4'11 .642
APPLICANT au\ L �q 11A 1jIrnl�Alailing Address: l
City: State'_Zip: Contact No: Email:
'Please fir out applicant information if different han landowner
CONTACT NAME APPLYING IN OFFICE:
� Phone#
f�
PROPERTY LOCATION:Subdivision: 11 . 7th �� .s 1 - - _ Lot#: Li Lot Size: '99f�
State Road# `� `' bin
Road Name: `i. • `\P�'C! &4VT 1__. LPL!
Book 8 Pagek. _` OM's.
Parcel:[7f�t�,�D�SIV pin 3 �s/�L PIN: Sid*
i3�/ — I S LPy (rc
Zoning2a0Nood Zone: X Watershed': 11"7 Deed Book 8 Page�[&P 11 Ems-'Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: j+*l /tf'
$ SFD:(Sizer x Bedrooms:.#Baths: ` Basement(w/wo bath):Y 7 Garage:D Deck: k Crawl Space: Slab:_Slab:Mon ithic
(Is the bonus room finished?(_)yes ( )no w/a dot?(_)yes (_)no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms_#Baths_Basement(w/wo bath)_Garage:_Site Built Deck:_ On Frame_Off Frame_
(Is the second floor finished?(_)yes (_)no Any other site built additions?(J yes (J no
❑ Manufactured Home: SW_DW TW(Size x )#Bedrooms: Garage: (site built?_)Deck: (site built?_)
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use: Hours of Operation: #Employees:
❑ Addition/Accessory/Other(Size x )Use: Closets in addition?(J 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) _Existing Septic Tank(Complete Checklist) /- County Sewer
Does owner of this tract of land,own land that contains a manufactured home within five hundred feet(500')of tract listed above?(_)yes (_)no
Does the property contain any easements whether underground or overhead L)yes (41 no
Structures(existing or proposed):Single family dwellings:�lanufactured Homes: Other(specify):
Required Residential qProperty Line Setbacks: Comments:
Front Minimum 1� Actual`^t3
Rear 2 0/ ,...Q .---t
LAM
1�
Closest Side l �ll >
Sidestreet'corner lot
Nearest Building
on same lot
Presidential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
� e
SPECIFIC DIRECTIO TO THEPROPERTY :QC C1-60a 1VV 2! ( �0LC ��c\hQL U1JR . i � ris on - heIrcr. , ] b v� t
.iford
i5 -the.,Cour r .
If permits are grantee I a.,ee • m •all ordma es and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state the oreg 2.• s. - f,•1; r to nd correct to the be f my knowledge. Permit sub revocation if false information is provided.
iw
g re of Owner or ner's fl(g t e
r . r
"It is the owner/applicants responsibility to provide the county with any applicable Information about the subject property,Including but not limited
to:boundary information,house 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 6 months from the Initial date if permits have not been issued"
Reslential Land Use AVPllcation Page 2 of 2 03/11
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PLANA L -
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Co *BEDROOMS
ALu Date /A i V zfr inic or
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09/09111 Application#
Harnett County Central Permitting
PO Box 85 Lamgton NC 27548
Each secron below to be filled out 910 893 7525 Fax 910 893 2793 www harnett ore/permits
by whomever performing work
Must be owner or licensed
contractor Address company A. !motion for Residential Buil.in, and T ,des Permit
name 8 phone must match I ,
Owner s Name �i�. . p:eh it$11$ $ $$2 1IL - ti II / Date �j
Site Address \ Rna,E�•1ir1�1R��7�• Pho ` • % I . � ""
Directions to fobs = fro Lillington ►.'l!a S O �re____
il=Mk
Subdivision 1 Lot I
Description of Proposed Work o ma 1\ \\ O\\?Q #of Bedrooms
Heated SF XUnheated SF G a Finished Bonus aRoomm'1i n
Qau,k lc Ira ` Telephone;
Crawl Space Q Slab
1Th Ihlo- 203- �J363
� `� Telep nq,\ (�
Iuildiin2ng����IContractors Compact hamlet //t 1(. k�c Ame5 ,/w� �fvakVia ' I
"U '�(J*� IS rFJ G(J Email Address 'I `� lY
Address
License#
Electrical Contractor Information (temps T-Pole Yes No
D cri ion of Work Service Size
//��s\\ i .0 i a h - 14- Toll ry{, /�
nitric&Contrackor s�ClomP YName �1 10c Telep/e(1phonne
/�yt�,�� U1l Q.�li r"��,t"��
1 ��� Prl05 LCA�Q r‘Jl Email Addre\ss
Address 1
, 911-- ) _
License#
Mechanical/HVAC Contractor Information
Description of Work
Mechanical Contractors Company Name Telephone
Address
Email Address
n LAJkllJ
License#
Plumbing Contractor Information
Description of Work
#Baths
Plumbing Contractors Company Name Telephone
Address Email Address
V w- r
License#
Insulation Contractor Information
Insul n ontradtors 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 Harnett County Zoning Ordinance I state the information on the above
contractors is correct as known to me and that by sinning below I have obtained all subcontractors
permission to obtain these permits 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
PIRED FEES-6 Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
r :> ler cu nt ee sc dui � I �II�
C .� . 1� �
Sig ire III er/Contractor/ icer(s)o Corporation Date
Affidavit for Workers Compensation NC 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) 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 a is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of worker s compensation insurance pnor
to issuance of the perms and at any time dunng the permitted work from any person firm or corporation
carrying out the
Company or Nam. n
Sign w/Title C At r 1 1 _ Date_���.
June 27, 2018
Tara Sabatine-Holmes and Paul Holmes are not financing the building of their home on 15 Williford
Lane in Spring Lake, North Carolina.
state of 1.1C
county a CutacceiattrW,
InsfrumeM was
Ta . :batine-H.Imes4t: . SDS
awn^i4... Ut-1 2o7-3
LOTOLANGI S PRUKOP
Paul Holmes '1rk. Notary Public, North Caroline
jr; IHoke 0420Y
I. My Commlplon Expires
March 14,,2023