LAND USELit' - C (t, Application # ~~(JOl (Q S CQ~
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COUNTY OF HARNETT LAND USE APPLICATION W ;?&I
Central Permit)(ng 102 E. Front Street, Lillington, NC 21546 Phone: (910) 8934759 Fax: (910) 893-2793
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$ Ll h l (/a J Mailing Address: GJ / fJ .
City.. p"hT~'{fi State: Zip: Z sO f' ~9
Phone
e h ~~~Yr'► ✓~i Mailing Address: f ~
t State: Zip: Phone O e( ht 0
PROPERTY LOCATION: SR SR Name:
Parcel: Irks- - cy) -n PIN. ~.r
Zoning: Subdivision:
Lot Lot Size: _
Flood Plain: Panel: _ Watershed: Deed Book/Page: 2kq--I Plat Book/Page: 7
If located with a Watershed indicate the % of impervious Surface: '
40( IV 7D X21„-ef _
Lj In t:Y t ay /Qal 'a Al~/I T~1/ //i, hr'tI A~ 1r,t1e To
~ •a K. ffo o~ ~0 -e n fro .~~t o L 5~" -P.
PROPOSED USE:
X Sg Family Dwelling (Size # of Bedrooms # Baths Basement (w/wo bath) _ Garag" ~k
Multi-Famit Dwellin N~xts
Y g No. Bedrooms/Unit
O Manufactured Home (Size x_) # of Bedtboms Garage Deck
Comments:
Number of persons per household
❑ Business Sq. Ft. Retail Space Type I
❑ Industry Sq. Ft. Type
❑ Home Occupation (Size x# Rooms
Use
❑ Accessory Building (Size x_) Use
❑ Addition to Existing Buillddiin~gSize x Use
Other V
a Supply: L~H'~~L~^►h'' - U Well (No. dwellings ) Other
Sewage Supply: l Iw Septic Tank U Existing Septic T C--) County Sewer U Other
Erosion & Sedimentation Control Plan Required? YES NO
Structures on this tract of land: Single family dwellings manufactured om Other (specify)
Property owner of this tract of land own land that contains an a utt n t Meet (500') of tract listed above? YE NO
Required Property Line Setbacks: Minimum Actual Minimum Actual
Front D Rear t .
Side 10 /01 130 _ Comer
Nearest Building 140 L%..-j1z;o1
If permits are granted I agree to conform to all ordinances and the laws of the State of North Carolina regulating such work and the specifications or plans submitted. I
hereby swear that the foregoing statements are accurate and correct to the best of my knowledge.
W In f
Signature of Owner or ~wnA ent pact
"This application expires 6 months from the date issued if no permits have been issued"
A RECORDED SURVEY PLAT AND RECORDED DEED ARE REQUIRED WHEN APPLYING FOR A LAND USE PERMIT
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