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Initial Application Date. 1 e a N OS Application # /0 X500 -29 7 L f
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 2 546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.hametLorgtpermits
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LANDOWNER: S (6/04/1/ �0
!!£3 A'£3 a ,f o{Q'� Mailing 5 Address: PQ Oct ( f76 Aiiiiiirliar
City: if �frt State: Pt Zip: 2-7 Home #: Contact #:
T. APPLICANT: -- 'HAJ 17)• NIA/A Mailing Address: Po. Box 36i
L.
j City: /_4L&1NGToN State: NC zip: 275111 Home #: 9/0 —S /+/ -2222 Contact #:
'Please fill out applicant Information if different than landowner ,, ,/
U 1 CONTACT NAME APPLYING IN OFFICE: 2J OHN .2 1t4 Phone ft 9/ 0 -sly- 2222.
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PROPERTY LOCATION: Subdivision w /phase or section: C oAS IA K{ en . 1— Lot #: 9 Lot Acreage: (•
State Road #: (' fob Stale Road Name: Bo 2L LA r - E ■2 0 Map Book &Page: `TA / l 5
Parcel: Oki o(99 ono to o l PIN: OW 2. - A5 1 2. 000
Zoning:'R3o Flood Zone: x Watershed: t 1e' Deed Book&Page: 7 - 7—( 11. / q.WA PE Premise #:
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: I fAvrc, FR0 :t 4 &6 hi IreeSfrz'o v t' 4a/well
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- PPpROPOSED USE: • Homes with FFrrogress Energy as service l provider need to supply premi number from Progress Energy Circle:
X SFD (Size7D•2x 55 ) # Bedrooms 3 # Baths 3 Basement (w /wo bath) N Garage Deck ti Crawl Space) Slab
(Is the bonus room finished? Y w/ a closet /Y it so add in with # bedrooms)
❑ Mod (Sizex ) # 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? ) Deck (site built? 1
❑ Duplex (Sizex ) No. Buildings No. Bedrooms/Unit
❑ Home Occupation # Rooms Use Hours of Operation: #Employees
❑ Addition/Accessory/Other (Size x ) Use Closets In addition( )yes ( )no
Water Supply: (i /County (J New Well ( ) Existing Well (No. dwellings ) MUST have operable water before final
Sewage Supply: (j✓ New Septic Tank (Complete New Tank Checklist) (J Existing Septic Tank (J County Sewer �
Property owner of This tract of land own land that contains a manufactured home Win five hundred feet (500') of tract listed above? OYES L‘,10
NO
Structures (existing or proposed): Single family dwellings I 9 Manufactured Homes Other (specify)
Required Residential Property Line Setbacks: Comments:
Front Minimum 3 Actual 76 etts#'ocfo -GE G1/4_0C t.._tL.� Iact.— oC 1FUu..
X
Rear 25 • i r i Z, N- wcj
'Ttr Yoe- POOL jT L.25€ . ,/ // L
Closest Side (l7 -- _ 7 '• M - l0 n 4. E Aid T 0 9'OJA/
Sideslreet/corner lot 2 0 bk i 0 7 q o /' 6if
Nearest Building Co 2 0
on same lot
If permits are granted I agree to conform to all ordinances and laws of the Slate of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoi a Cements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
1� re t �' ►�i:_u •� _ _ 07 6 /ed o
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Signature of Owner or Owner'et ent Date
"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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DISTRICT 11 - �- "- USE ���
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