LAND USE it
Initial Application Dale: S ]Dq Application If V "I JL/~ dj
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 08 E. E! nil Street, lin ton, NC 2754 Phone: (910) 893-7525 Fax: (910) 893-2793 www.harnetl.org/permits
LANDOWNER: ~~a~ ~y Mailing Address: '7 ~l S~VU
City: Qat- State:!\y L Zip: ~M~'W Home Contact
APPLICANT': tC'efJtll-~ a✓~~CjyJ Mailing Address: t t 3 t4 CcJ U 0 6/.>
Cilly: State:Q•C-Zip: lIome#: 7Vqi /gC2Contact
Please fill out applicant information If different than landowner
CONTACT NAME APPLYING IN OFFICE: -y~-~ Phone lr.
PROPERTY LOCATION: Subdivision: C! T1'h ,i I (Q- ~~,`nf~-~\ OI 1 L~ tt, :-)Lot Size
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State Road Pl State Road Name : l U.~.I v~,t 1 1 ( 1I 1L-1 1 I Map Book&Page--7995 /n( F 7
Parcel: C " "OLDc ) X7 5 _ PIN: QSI 0 q t J) /
- SS 2' UVIJ
Zoning : Flood Zone: Watershed: I I l Deed Book&Page: f Power Company:
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Or /4U y e? /j-Ke 94112-7
to Cpw,~,ed M 1-40 L/I a N &,`/C ee-xr Qb raN L c:r 6 N
&Ao e-4&tj It 2b Gry / . s n., z /e 5 r,e N 2T : A-) i-C)
HvlekshI'Q-C !~/r+L~~ N R4) &70 3 4/1," If -C 0
IL~rSh~t~ C u/zi
PROPOSED USE: (Include Bonus room as a bedroom if it has a closet) Circle:
SFD (Siz x1) # Bedrooms , # Baths Basement (w/wo bath) Garage Deck rawl Space Slab
❑ Mod (Size zi) # Bedrooms- It Baths- Basement (w/wo bath) Garage Site Built Deck ON Frame / OFF
Manufactured Home: _SW _DW TW (Size_x) # Bedrooms Garage site built?Deck(site buI
❑I1 Duplex (Size x_) No. Buildings No. Bedrooms/Unit
❑ 1 Home Occupation If Rooms- Use Hours of Operation: #Employees
AdditloNAccessory/Other (Size-? x~ U 1 Closets in addition yes no
Lc% a seCA,,
water Supply: County Well (No. dwellings MUST have operable water before final
III Sewage Supply: New Septic Tank (Complete New Tank Checklist) ,!sling Septic Tank LJ County Sewer
Property owner of this tract of land own land that contains a manufactured home wfin five hundred feel (500') of tract listed above?' r(JYES (JNO
Structures (existing or proposed): Single family dwellings _ij<-':~,)_ Manufactured Homes Other (specify)
Comments: StZ - p
Required Residential Property Line Setbacks:
Front Minimum 35 Actual SU WtAry\-Cr (,0QL1 C0' y D
Rear ss J1 i -u.g~-,+1-/-J=
Closest Side IQ
SideslreeVcorner lot 'C'^^ _
Ne l rest Building
on same lot
If pI rmits are granted I agree to conform to all ordinances and laws of the Stale of North Carolina regulating such work and the specifications of plans submitted.
I(hreby state that foregoing statements are accurate and correct to the best of my knowledge. Permit subject to revocation it false information is provided.
Signature of Owner or Owner's Agent Date
I "This application expires 6 months from the initial date if no permits have been Issued"
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
Please use Blue or Black Ink ONLY
2/08
05/11/2009 10:45 9108269022 REGENCY PAGE 01
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