SETUP
Harnett County Central Permitting /
PO Box 65 Lillington, NC 27546
Telephone Number: 910-893-4759
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 manufaytured home)
Name:G d~cct'6TE Address:01 A eVOK-T Au$Uh
City: F~Ax _ V /'d(~ State: ~ Zip: J_ ysa G Daytime Phone: f7Fy >7~/ 92Z
Landowne~Information (~o be gompleted by landowner, if diV nt than above)
Name: Address: 7t~ Grpvti ~~i
City: - ate: Zip: Daytime Phone: ( )
Part II - Contractor Information (To be complete by Con actors or Homeowner, if applicable) 01 A. Set-Up Contractor Company Name: M Ig' ate Lic#_
Phone: -to IPLV .1 Address:
City: State: °L Zip:
Si natu
B. Electrical Contractor Company Na e: S to Lic# 4
Phone:Y -S-S - 3 Address:
City: F St e: i .
Si natu e: ~r
C. Mechanic 1 C tr or Company Name: State Lic#
Phone: 2~'9 Address: /
City: St Zip: 9E-2 5 Z142 Cz
SSlanat6ret-1/ 74)l A /,I
D. Plumbing Con for mpany Name: (State Lic# ~307G
Phone: Address: V t-City: - ar tate: NC Zip:
a7S 4
Sianature. ,y,,,~.s~~,cN4.~ f~
Part III - Manufactured Home Information
_New Used
,N(Singlewide _Doublewide _Triplewide
Model Year: Ic
t~'!g' Size:j~X_!50
Private Property Manufactured Home Park
Park Name: Lot Number: ~f! s! L
r
Directions to site or Manufactured Home Park from Lillington:
7V 1A147
rr r
S
I hereby certify that I have the authority to apply for this permit, that the application is correct including the
contractor information and signatures, 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 correct or false information has been provided that this permit could be
rev ed. p iwl S-31 -01
-
nature of Owner or Agent Date
'Effective July 1, 2004, a Harnett County Tax Department Moving Permit must be purchased before a Set Up Permit will be issued. -
06/04
i
S M s O 0 m . 0 m c y 0 -4 p GREAT 4.
€ 9 m 9 < : H m z * a
m o -f c_ H O x
3 w` 'm 3 m f o_ z y
v 1 A d N - C _ ry Ol _ fA O I3 ,y
D m 3 M o m #
a M M
z CL l< %c
In 0. V) co 0 >
m 39 Om m o c0 C, 3 O X
-1 -0
= 0e o0 a,- as S o .00. z m
cM
m ~0 ~a 0.-- OL -S ~a ,
a H Sd a- A - 0 m
M S'O 02 w , 3 , W
< 3c mm w
0 0 r
3 » w m x - t A
O m -
m m C
O 3 v L`
C~
c y _
o' pop
2 o. Q1
0 17
s
o
s 0 v'x a a a
o; qCL a
N W O G W fH
m ~ g ✓ _ 3 -
to
n n
c c r
v
W N=. Z
❑
JCD-
0 c G
'D 0
V~
M CD
0 v 'v v
C 7 C 'T r 0 „ 1N N
00 now
- CD CD
T ff n
-0 f S S
(D W
lb m
I a
0 3 PER
0. 0.
'0 CD