DEMOLITION APPLICATION 7 _ /V 1os , 2 23 .77'
Initial Application Date: 2 �- h Application # / C 7 (779 7 7
COUNTY OF HARNETT DEMOLITION APPLICATION
108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 Fax:(910) 893 -2793 www.harnett.org/permits
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Land Owner: �Vt,�2t :�f E L � rnc Mailing Address: O Mail wzrL '344 7
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Cit l`a t N LXc v im ' , VII- StateV Zip: , ` Home #: Contact #: 0 71 . 4 Z) - CAI $$
0_666C- APPLICANT *: 6C/ D0121 Mailing Address: 0• Vag UJ (L t ¢ 91
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City: t5Ul1 W State ) Zip:36S0 Home #: Contact #: (o1$- 45 -4
*Please fill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: go 6012-1( w., 13 021v1 Phone #: X01 fit - cfrca- &('sS
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PROPERTY LOCATION: Subdivision: IV ij Lot Acreage:h 2. 3 vi
State Road #: 15 54 State Road Name: gget C,p 2. 0.
Parcel: r)1 ( ,) PIN: I (0 t -0 `` 53 0V Zoning:I4 zone:
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: rig (62, 1101 2,10 M r0 Audi la-s, riC2/v
2t “ on to �y 55. Gn %iao�r
o. z &ticks 4 ru.rzn) Le-14. ON WUt Tuft tel., �,LL w M Gfuuert 2D Port Ann?. Co nt i ( % . T4 l & tens r vrt, 06 eel/ tXbn t ir6
;IAAse{nd Co. 2p. - (uPQ) Egk4o4 14 l/C. 0nk eo. litain4 047meedbatly 15,4 ono /61411 a.
await 'oil le, -tunn l;a.�f on i CoBb led. t4iZni ipp ,, 3 / ° 2�9 ft16
Structure(s) to be demolished & removed: Single family dwelling Manufactured Home Other (specify)
Structures (existing and/or proposed): Single family dwellings Manufactured Homes Other (specify)
Water Supply: ..A County (_) Existing Well
Sewage Supply: (X) Existing Septic Tank () County Sewer
* If a new structure is to be replaced on this lot, please ensure that existing septic system is not damaged.
* If an existing well is on site and is to be discontinued, please contact Harnett County Environmental Health for assistance.
*Upon the issuance of the Certificate of Compliance, the Harnett County Tax Department shall be notified of the removal to
ensure proper listing.
*The demolition contractor is responsible for submitting verification of proper disposal prior to the Final inspection.
* *PLEASE NOTE* *Failure to completely demolish, remove, and clear the premises will result in the withholding of the Certificate
of Compliance. Thus, future permits for the property will be denied, and fines may be imposed for failure to complete demolition/
removal.
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 r y ss to at foreg S W,%' ' ents 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
**This application expires 6 months from the initial date if no permits have been issued **
S: \Planning and Inspections Files\FORMSICP Forms
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