03-5-8173Rcation Date: 't /
Central Permitting
LANDOWNER:
/City: �^ ]
102 E. Front Street, Lillington, NC 27546
Phone: (910) 8934759
Mailing Address: !
State: 4A,_ Zip: X33
Mailing Address:
APPLICANT: r pp��
(� State: NL Zip: 33 -Phone #: E212 241
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76POSED USE:
Sg. Family Dwelling (Si=2 _ _2_ # of Bedrooms #Baths 3_ S Basement (w/wo bath) Garage Deck
❑ Multi - Family Dwelling No. Units
No. Bedrooms/Unit
❑ Manufactured Home (Size x_—i # of Bedrooms Garage Deck c0ld_&
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❑
0
0
0
O
Comments:
Number of persons per household 2
Business.. Sq. Ft. Retail Space
Industry Sq. rt.
Home Occupation (Size x_) # Rooms
Accessory Building (Size x_) Use
Addition to Existing Building (Size x___) Use
Type
Type
Use
❑ Other
Water Supply: County (__) Well (No. dwellings Other
Sewage Supply ;New Septic Tank U Existing Septic Tank L� County Sewer (� Other
Erosion 8c Sedime�nta`tion Control Plan Required? YES NO
Structures on this tract of land: Single family dwellings Manufactured homes Other (specify)
Property owner of this tract of land own land that contains a manufactured home w /in five hundred feet (500') of tract listed above? YES O
Required Property Line Setbacks: Minimum/ Actual j r Minimum Actual/
Front '� ✓� Rear
,
Side ` y / Comer J+
Nearest Building
If permits are granted I agree to conform to all ordinances and the laws of the State of North Carolina regulating such work and the specifications or plans submitted. I
hereby swear that the foregoing statements are accurate and correct to the best of my knowledge,
iig lure of Owner or Owner's Agent Date
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* *This application expires 6 months from the date issued if no permits have been issue/
A RECORDED SURVEY PLAT AND RECORDED DEED ARE REQUIRED WHEN APPLYING FOR A LAND USE PERMIT
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