land useInitial Application Date: � Application #
DRB # CU #
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.harnett.org /permits
LANDOWNER: 4�// - I or o t `2-0. /} � Mailing Address: (� %
City: r f C Oo >i �'' Stater Zip: r t. ontact # > `J � C aiL
APPLICANT, *: n r > /1 .`I,� Mailing Address: 0 \ 3 i.-
City: L, g C `t, G State: Vi ( Zip:+ Contact # 710 & , – r"/-- Email:
*Please fill out applicbfit information if different than landowner
CONTACT NAME APPLYING IN OFFICE: Phone #
PROPERTY LOCATION: Subdivision: J% / Lit #: Lot Size:
State Road # State Road Name: v % �2 / %Map Book &Page: /
Parcel: `� ✓ �✓ �� 1�� PIN: �E� 0 — 14�
r
Zoning: L Flood Zone: Watershed: Deed Book &Page: / �- 31 Power Company *:
*New structures with Progress Energy as service provider need to supply premise number
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
PROPOSED USE:
❑ Multi - Family Dwelling No. Units:
❑ Business Sq. Ft. Retail Space:
❑ Daycare # Preschoolers:
❑ Industry Sq. Ft: Type:
No. Bedrooms /Unit:
Type: &°c S Jor It # Employees:
# Afterschoolers: # Employees: _
❑ Church Seating Capacity: # Bathrooms:
❑ Accessory/Addition /Other (Size —X—) Use:
Water Supply: _
Sewage Supply: _
Comments: — 67
County
Existing Well
# Employees:
Kitchen:
New Well (# of dwellings using well
from Progress Energy.
Hours of Operation: -P -,,4— _ �p
Hours of Operation:
Hours of Operation:
) *MUST have operable water before final
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.
Signature of Owner 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
Commercial Land Use Application Page 1 of 1 08/10