LAND USE Initial Application Date: _ 3 _ 1, — SGNED 7 — /f, Application # /9 % O , 23 r/ 0
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' COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permilting 108 E. Frontt Street, Lillington, NC 27546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.harnettorg/pemiits
LANDOWNER: X1,1 £CI l s / Mailing Address: A O0.Y ?5b
City: 81J 1 Zs (re 4! -!'� State: N C Zip: Z 75 - e6 Home #: Contact #:
APPLICANT *: Mailing Address:
City: State: Zip: Home #: Contact #:
'Please fill out applicant information if different than landowner x 7 - rr -7
CONTACT NAME APPLYING IN OFFICE: --:t Obi S JrZ %'r Phone #: j/ f / % / oo
PROPE LOCATION:
' / OCATI — ON: Subdivision w /phase or section: I' P / a, /i LA , ? Lot #L Lot AAtcreage: (����
State Roal1 i I State Road �. e 2 7 / Map Bo &Page X/ f/ 7C d /
Parcel:/ 942✓ Oogg 04 q PIN: O( - 20— Zy z /
/ Zoning: ,0 Flood Zone: /I Watershed:, Deed Book&Page: / / 9 , ?PE Premise #:
SPECIFIC DIRECTIONS TO THE
,U PROPERTY FROM LILLINGTON: � �,
A] 424 ! i 4" D 6w /� q
.. Q/► • ", ll lr' .44 ∎V a I ":f4�
TyAJ i- r r)wfc c�i�T r/ QI ur �Ivs'l �Os5�7J A�and1u4de /V iz /ia'aj
,1P /,?ex. % ✓1+/. /-act444 4-e/, % '� 7 Ctr5F ON /a
PROPOSED USE: 'Homes with Progress Energy as service provider need to supply premise number from Progress Energy Circle:
❑ SFD (Size x ) # Bedrooms # Baths Basement (w /wo bath) Garage Deck Crawl Space / Slab
(Is the bonus room finished? w/ a closet if so add in with # bedrooms)
❑ Mod (Size x ) # Bedrooms # Baths Basement (w /wo bath) Garage Site Built Deck ON Frame / OFF
(Is the second floor finished? Any other site built additions? )
O Manufactured Horne: SW DW TW (Size x 1 # Bedrooms Garage (site built? ) Deck (site built? )
❑ Duplex (Size x ) No. Buildings No. Bedrooms /Unit
me Occupation # Rooms G Use Hours of Operation: #Employees
Addition/Accessory /Other (Size / /J x 2 / Use /7.Z S/4.Q1F Closets in addition( )yes no
Water Supply: (_) County (i New Well (_) Existing Well (No. dwellings ) MUST have operable water before final
Sewage Supply: (J New Septic Tank (Complete New Tank Checklist) O Existing Septic Tank ( ) County Sewer 774 e
Property owner of this tract • .. own land that contains a manufactured home w /in five hundred feet (500') of tract listed above? (_)YES NO
Structures (existing .:ingfe family dwellings Manufactured Homes Other (specify) /o L • fT
Required Residential Property Line Setbacks: Co]m�9 nts:
Front Minimum Actual RY/ { jra �/y7E //2 „v
Rear Y
Closest Side
Sidestreet/corner lot
Nearest Building
on same lot
If permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
SI n ure of Own er or Owns Agent ... Data
"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
LAND USE 5/08
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