LAND USE Initial Application Dale: 7- / Application # / a n z 7 z
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 ` www.harnetl.org/pemdts
LANDOWNER: POI- u • LO Z44:7- . e 4:1' Zt.* 4Z Mailing Address: 219 LE oti0I Z V'�. •
City: SSZNr • st*Aok State: h&G Zip: ZA3at0 Horne #: 510,' - #: ("4%0 «80-2805
APPLICANT': S P. M Y Mailing Address:
City: State: Zip: Home It Contact #:
'Please fill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: - SP. t'K / /J/ /I y g / Phone #:
PROPERTY LOCATION: Subdivision w /phase or section: OVLf/ui'Ai (/!/
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L� -- Lot #: ! 7 0 Lot Acreage: L:2 State Road
4 --. 1 1 dd #: / ✓ O
State Road Name:: / �/ / Map Book&Page: Z � / 33/
Parcel: ✓ / / n / / 0 J 2 I to o PIN: O? I -7 2 — / 7 4— cz 5 , 000
Zoning: ,q$ 10 NI, Flood Zone: 4" Watershed: eed Book &Page: 23Z/, f77 PE Premise #:
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILUNGTON: t AV.t t►wxi 2, \Q 5 Tov s, S 17—gy,s 2V ■11 Q,
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PROPOSED USE: 'Homes with Progress Energy as service provider need to supply premise number from Progress Energy Circle:
❑ SFD (Size x 1# 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 ) It Bedrooms_ # Baths_ Basement (w /wo bath) Garage Site Built Deck ON Frame / OFF
(Is the second floor finished? Any other site built additions?
❑ Manufactured Home: _SW _DW TW (Size x ) # Bedrooms Garage _(site built? 1 Deck (site built? )
❑ Duplex (Size x ) No. Buildings No. Bedrooms/Unit
❑ Home Occupation # Rooms Use Hours of Operation: #Employees
'� Addition/Accessory/Other (Size %_ `' 'x 8 ) Use 'R ot O t $'{ 7i'1 w7g ea. CM' Closets in addition( )yes Lino
Water Supply: (4 County (_J New Well (J Existing Well (No. dwellings ) MUST have operable water before final
Sewage Supply: (J New Septic Tank (Complete New Tank Checklist) U Existing Septic Tank ( County Sewer
Property owner of this tract of land own land that contains a manufactured home w/in five hundred feet (500') of tract listed above? (DYES (JNO
Structures (existing or proposed): Single family dwellings f itr Manufactured Homes Other (specify) C_)/T o 5 ton�,44 (
Required Resldentlal Property Line Setbacks: Comments:
Front Minimum 35 Actual
Rear
Closest Side 10
Sidestreet/corner lot z- D
Nearest Building (a
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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Signature of Owner or Owner's Agent Date
"Thla 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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