LAND USE R Initial Application Date' , Application # lo s 0 o �-Il a 2/01'
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 27546 1 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.harnett.orglpermits
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LANDOWNER: I v a lt-nA c- ( - t f s C e c Mailing Address: Q.l M C rvv ie F-e s Gti 'Or
City: L.,11Mbton �+ 11 State:MC Zip: »)T4(o Contact # \tn rin 11(a\ Email: 'Me.l - 4 rvootol.c
APPLICANT': MP do f C-s 1'Y P Mailing Address:
City: State: Zip: Contact # Email:
'Please fill out applicant information if different than landowner q CONTACT NAME APPLYING IN OFFICE: MP \ het it ISM e { o q Phone # �h gq3 -) (
PROPERTY LO : Subdivision: Mc ml P OW k \ 1 ( CII Lot #: Lot Size: (\C l X 7-0(10 State Road # ''-{ \ k � State Road Mama: /\/\ anti e Pe rC OO 1, iM 0 r � I Map Book &Page`^ O l l .3 9
Parcel: '!(�� T
11J Flood Zone: Watershed: 1 3 0G).30 b(kcci CAD n_C PIN: Ir�� ���))tJ 3 0(4 Power — Company*: f l q . Ob
Zoning. g / / 3
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'New structures with Progress Energy as service provider need to supply premise number ss from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: rack q a l I'J l L O A is rv, ?• �l P (1 1tc
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PROPOSED USE:
❑ SFD: (Size x) # Bedrooms: _ # Baths: _ Basement (w /wo bath): Garage: Deck: Crawl Space: _ Slab: _
(Is the bonus room finished? (_) yes (_)no w/ a closet? (_) yes (_)no (if yes add in with # bedrooms)
❑ Mod: (Size x ) # Bedrooms_ # Baths_ Basement (w/wo bath) Garage:_ Site Built Deck:_ On Frame Off Frame_
(Is the second floor finished? (_) yes ( )no Any other site built additions? (_) yes (_)no
❑ Manufactured Home: _SW _DW TW (Size ) # Bedrooms: Garage: (site built ?) Deck: (site built ?_)
❑ Duplex: (Size x) No. Buildings: No. Bedrooms Per Unit:
❑ Home Occupation: # Rooms: Use: Hours of Operation: #Employees:
tilZ Addition /Accessory/Other: (Size eq ? • se:
1 - Nf'e._ OIJ�� Closets in addition? (_) yes ( �rt6
Water Supply: ✓ County Existing Well _ New Well (# of dwellings using well ) 'MUST have operable water before final
Sewage Supply: New Septic Tank (Complete Checklist) Existing Septic Tank (Complete Checklist) County Sewer ' '
Does owner of this tract of land, own land that contains a manufactured home within five hundred feet (500') of tract listed above? ( ) yes tY /rro
Structures (existing or proposed): Single family dwellings: Manufactlred Homes: Othe (specify):
Required Residential Properly Line Setbacks:: Comments: jivr• Melt,
Front Minimum a s Actual v
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Rear kLL D
Closest Side A0 _LLCL
Sidestreet/comer lot
Nearest Building ( 0
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.
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Sfgnatu Owns or Owner's Agent Date
"This application expires 6 months from the initial date if permits have not been issued"
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
Residential Land Use Application 1 of 1 03110
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