LAND USE Initial Application Date: 4 — IS — 1Q Application #
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COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting p 108 E. Front Street, Lillington, NC 27548 Phone: (910) 893 -7525 Fax:
� ((x9110) 893 -2793 www.hamett.org /permits
LANDOWNER It CRl1m� Mailing Address: x,V2 CA4thillk7le• t ¢ Q/ •
City: EVIlyv ett ;in*: NON State: IX"' Zip).2. /. 0 Contact # R Id • X1 - I'19S Email:
APPLICANT': m SNe SAO/ , ! T rtt 4 Address: I p 4 0 A a 1 c'd
City: Kip l 9 stater zip:2 contact#g19'Z /0• a R! Email: Swe )7 TrftE,bpr @v7
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*Please fill ut applicant information If different than landowner p� 1 2 f of . �M
CONTACT NAME APPLYING IN OFFICE: 7 h 7 , -- t �• ej( Phone # - t 19 " /V ✓ 74 9) �s�
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PROPERTY LOCATION: Subdivision: h /l1/Ul� // , it 2 Lot #: Lott Size : 42 / / .J Y
State Road # A i I 1 / State Road Name:: it 4 t / Map Book &PPaage: 6�7 / /
Parcel: 1 Q n //11 !/ Lei `� ZZ PL //!/ PIN: � ZI // O `7 /`' r� ~ 35' �` b,
Zoning: / ' ". ‘'Flood Zone:_ Watershed: Deed Book&Page: 7GSU / /1F4 Power Company':
New structures with Progress Energy as service provider need to supply premise number Cr from Progress Energy.
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SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: II d 1 Y• 440/Y 142,11 Clam* Pr Af
PROPOSED USE:
❑ Multi- Family Dwelling No. Units: No. Bedrooms/Unit:
❑ Business Sq. FL Retail Space: Type: # Employees: Hours of Operation:
❑ Daycare # Preschoolers: # Afterschoolers: # Employees: Hours of Operation:
❑ Industry Sq. Ft: Type: # Employees: Hours of Operation:
A❑ urch Seating Capacity: # Bathroo : Kitchen:
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Accessory/AdditionfOther (Size /� x 4 > Use: /ti4i/ 5 jn
Wa er Supply: ./ _ Existing Well _ New Well (# flings using well ) 'MUST have operable water before final
Sewage Supply: _ Septic Ta nk (Camplete 9hhlist) Existing Septic Tank (Complete Checklist) County Sewer
Comments: Ct:L•J 8 it / x (
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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 bes my knowledge. Permit subject to revocation if false information is provided.
Signature of Owner Owner 's_Age t V Date
"This application expires 6 months from the Initial date if permits have not been Issued"
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A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED MRIPJi,APPLY#10 FOR LAND USE APPLICATION
Commercial Land Use Application Page 1 of 1 03/10
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