DOCUMENTS InItiaPAppllmtbn Date:n I l OI ( (l Application if 12Wim ) ' ` -t)
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPUCATON
Central Permitting 108 E.Front Street,Ullington,NC 27540 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.harnett.org/pernIs
^A RECORDED SURVEY MAR RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHENN/SUBNIITING A LAND USE APPUCATION"
LANDOWNER: 5 - III ITI`-rte 7'r CLI)5R-`V'CA1) �'/ Mailing Address: Ae S (AA4Z (ci-/4
city. (y state:/-J�- zlpc77SDI Contact No: elP-�7nC''9307 Email:.+.lQre48?-rT(/p PFfo<.Pax(
APPucIV4r;s-rn w tate Mailing Address. 5r, sOr
Cm: & State:/VC- aJlsl'f5?.1 Contact No: Ck/9-d6r-93o 7 Email: �g&tJkenfG@Ac/reyfti
'Please flu out implant Information x diflerem wanlandowner
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CONTACT NAME APPLYING IN OFFICES-&J2_ -Stec (tePrFF-1 n nPhone# Cl/9-,�&[9347
PROPERTY LOCATION:Subdivision: r)L / //Jl/Yf(7s t 'cCS/ ( /2QI Lot#: ) Lot Size: ' 8-7/
State Road#bn
5C l State Road Name; &2/IK/'T n,saf/L4a nri Map Book&Page: q(-)/(d l 7vU
Parcel: b n I , (13i 3 b3[ PIN: I Ls 1(�- 15 - 3a93 .001/4l
Zon l 1.]u Flood Zone: )C Watershed:A 1 Deed Book&Page: �title 'Cto'wer Company": h 1 re
'New structures with Progress Enemy as service provider need to supply premise number from Progress Energy.
PRO SED USE:
/Monolithic
SED:(Size 5 x_4)#Bedrooms�33 #Baths2c Basement(wAvo bath):�Oarage Deck:_Crawl Space:_Slab: Slab:_
(Is the bonus room finished?( s (_)no w/a closet?O yes ( •-11 0(H 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?(_J yes (_)no My other site built additions?(i yes (_,)no
❑ Manufactured Home:_SW_DW TW(Size x )#Bedrooms:_Garage: (site built?_)Deck: (site buil?_)
❑ Duplex:(Size_x_)No.Buildings: No.Bedrooms Per Unit:
U Hole Occupation:#Rooms: Use: Hours of Operation: *Employees:_
LI Addfon/Accessory/O/Other:(Size x 1 Use: Closets In addition?(J yes (_)no
Water Supply: —Go�unry _Existing Well _New Well(#of dwellings using well )'Must have operable water before final
Sewage Supply:i - 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 live hundred feet(500)of tract listed above?(i yes Ln-i-to
Does the property contain any easements whether underground or overhead(_)yes
Structures(existing • •roposed• .ingle family dwellings: Manufactured Homes: Other(apeclfy):
Required Residential Property Line Setbacks: Comments:
Front Minimum 55- Actual 410
Rear
Closest Side
Sidesbeet'comer lot
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 • 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO HE PROPERTY FROM j ILLINOTON: '4) su-- Cce-z 1- A.
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If permits are granted I a to norm to all ordinances and laws of the State of North Carolina regulating suds work and the spedgcations of plans submiaed.
I hereby state that fore; g _mens a a rata and correct to the best of my knowledge. Permit subject to revocation If false Information is provided.
Ii p{C 7 u(9. —/r
/ Sig re of Owrgf or Owner's Agent
ate
'tit is the ownerlapplIdns 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 S months from the Initial date R permits have not been issued"
Residential Land Use Application
Page 2 Of 2 03/11
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;PH m i SITE PLAN APPROVAL
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NAME: APPLICATION It:
*This application to be tilled 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
depen ' g upon documentation submitted. (Complete site plan=60 months;Complete plat=without expiration)
910-893-7525 option 1 CONFIRMATION it
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 aVfor 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 she. Do not grade property.
• All lots to be addressed within 10 business den after confirmation.$25.00 return trip fee maybe incurred
for failure to uncover outlet lid.mark house comers and properly 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 divan al end of recording for proof of request.
• Use Click2Gov or IVR to verity results. Once approved, proceed to Central Permitting for permits.
G 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) end then put Ild back In place. (Unless Inspection Is for a septic tank in a mobile home park)
• DO NOT LEAVE LIDS 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 recuest.
• Use Click2Gov or IVR to hear results.Once approved, proceed to Central Permitting for remaining permits.
SEPTIC
If appl g for authorization to construct please indicate desired system type(s): can be ranked in order of preference,must choose one.
!Z.-Accepted (_I Innovative (_) Conventional (_)Any
(_) Alternative LI 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:
(_}YES 110 Does the site contain any Jurisdictional Wetlands?
(_IVES (,4O Do you plan to have an AIjeation systcn now or in the future?
(_)YES (moi O Does or will the building contain any ?Please explain.
1_IYPS l4 N9 Are there any existing wells, springs,waterlines or Wastewater Systems on this property?
(_)YES ( O Is any wastewater going to be generated on the site other than domestic sewage?
(_EYES (11//NO Is the site subject to approval by any other Public Agency?
(_)YES ( Are there any Easements or Right of Ways on this property?
(—)YES ( 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 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 IAlely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
A . e "i mplete Site Evaluation Can Be Performed.
-/ .AC .' . i►+ / 7� -
PROP' 'TY O , . OR 0 '1' 'RS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) /DAT'E/(
/ 10/10
. 00109/11 Application#
Harnett County Central Permitting
EEO settee traces b be NWoutPO Box e5 llemgton NC 27548
by whomever Perla imo work 0108837626 Fax 8108832783 www Mmeso cm/permits
Malt be owner or lamed
Oona Address f pent' Application for Residential Building and Trades Penna
Gene B phone must meth //�/ eA
Owners Name S -491 le YLn�anXtco Date-7O—le
Site Address ,3.2Ri £4e 67< 4cscc i, 770/ , ji1(741 Phone 9/?-gor94o7
Directions tooq job site from Ldlmgton 4'Z/ -fp laiL-o (tee"( �77L� < f Z 7 p a
-71211a ( i.L • A91 /445 Car r144 /2c.../ i nz, U-, /a
Linz,
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Subdivision Lot
el
Description of Proposed Work /I12dA-/ MO/ #of Bedrooms 3
Heated SF /799 Unheated SF (G&G Finished Bonus Rooms ye S Crawl Space _Slab
General Contractor Information
Maas iQo.po,; /9 -en:- 9-90 7
Building Contractors Company Name � ae Telephone
31,S elpil/(c , e ,Cr 1041s AJc L/n//1JbtiYVp% (
Address Email Address
756,3a.
License#
Electrical Contractor Informabor � �/
Descnpbon of Work .t/e..rr rhe Service Size 7ew Amps T-Pole =7e6 No
7Jrc,4,, q-Ace_ ottani- 9/q-y19-39V(e
Electrical Contractors Company Name Telephone
(dr Lit i- Ode .. ,✓cl-
Address Email Address
4a007 Ce
License#
Aka} ccaUHVAC Contractor Information
Description of Work /V a}
( 7d'(Sifr„rc ge_, J Sri-2s R'- 0cfer
Mechanical Contractors Company Name/z, Telephone
Al a
b0 //5A/rrfc . CJIOA)47 tic_
Address / Email Address
License#
,// plumbing Contractor Information
Descnptron of Work /V 113,-e #Baths 7--
L 'riz s T9srelo fh 44.441<N `74* —53( milt(
Plumbing Contractors Company Name / 7) Telephone
1,,5! SG>a-bJ44xa-) l y /5o erd tic.
Address ( e Email Address
'a09
License#
InsuWion Contractor Information
/5d /rr--55 ,ViL_ ,�/
c- ( f KIK 9 77). - 9do0
Insulation t�radMrs Company Name di Addrrges Tune
'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
end 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 by sranlna below I have obtained all subcontractors
penyssron to obtain these wends 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 - MR FEES-e Months to 2 years permit reissue fee is$150 00 After 2 years reissue fee
is per a- schedule
•
'Ire Ware 7-ta -(x-
.
S ` ure of • rlContree(or101bcer(s)of Corporation Date
Affidavit for Worker's Compensation N C G $ 87.14
The underst ed 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
coGenng themselves
_Has no more than two(2)employees and no subcontractors
White 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 du'7'the permitted work from any person firm or corporation
carrying out the work
Company or N ���j/ ( Lt—(—
Sign w J I2' . _ Date'�O �(r
wy,
LIEN AGENT INFORMATION;
Effective April 1,2013
nt ,
y4 u
In accordance with North Carolina General Assembly Session Law 2012-158, gas
Inspection Departments are not allowed to issue any permit where the project cost
is $30,000 or more unless the application is for improvements to an existingtia
dwelling that the applicant uses as a residence OR the property owner has 4
designated a lien agent and provided the inspections office with the information
below:
Name of Lien Agent Snt V g-4u- tik\LrrJ.s>ucPc.'at t2tvat.l ll
Mailing address of Agent \Q W. e#Ak 4 . 611,v so-t_
Mma t51,, , At ( a75nL
Physical address of Agent \r{, 1A— role. Gf. Su £01
`Rica1ftsk , X . 0.--150
Telephone \-S 2 - f,6- 1zR -t -J Fax t-Q1° - 1'4— 5(p (-0 4
Email C-1ccppo„tNSnrc. c.ovA
The information will be attached to the permit record and a copy provided to the
applicant. The applicant is required to post a copy on the construction site.
Excerpt from North Carolina G.S. 160A-417:
"(Effective April 1,2013)No permit shall be issued pursuant to subdivision(1)of subsection(a)of
this section where the cost of the work is thirty thousand dollars ($30,000)or more, other than for
improvements to anexisting single-family residential dwelling unit as defined in G.S. 87-15.5(7)that
the applicant uses as a residence,unless the name,physical and mailing address,telephone number,
facsimile number,and electronic mail address of the lien agent designated by the owner pursuant to
G.S. 44A-11.1(a) is conspicuously set forth in the permit or in an attachment thereto. The building
permit may contain the lien agent's electronic mail address. The lien agent information for each
permit issued pursuant to this subsection shall be maintained by the inspection department in the
same manner and in the same location in which it maintains its record of building permits issued.-
HARNETT COUNTY RASH RECEIPTS
*me CUSTOMER RECEIPT aa*
Oper: TBROCK Type: CP Drawer:
Date: 7/10/18 52 Receipt no: 12546
Year Number Amount
2018 50844446
3281 BAILEYS %RDS
BENSON, NC 27504 _
B4 BP - Emu HEA'Tt FEES 9750.80
NEU TANK
S=MARK
Tender detail s7@8.80
CP CREDIT CARD *750.00
Total tendered 9750.00
Total payment
Trans date: 7/10/18 Tire: 'i:56:53
e* THANK YOU FOR YOUR PAYMENT **