03-5-8173RRcation Date: t / 3 Ap lication # Vl✓ �� J - / !1L
COUNTY OF H SE A C41CI701V
Central Permitting 102 E. Front Street, Lillington, NC 27546 Phone: (910) 8934759 / 3-
DOWNER: 1?J 4 �ti �'f�!— �'/ Mailing Address: .5,P4 ,
rcity.
�^ �— State: /A_ Zip: —431-20- Phone M J � %' &ke ji
APPLICANT: I AA C ��-� L _ Mailing Address: l / 11 _CPnJ �'�'�g7 L..r ✓t�e
rty: v
,,� _ State: .L Zip: � Phone
PROPERTY
Parcel: •_-„
Zoning: -jd-
Flood Plain: .
TO THE PROPERTY FROM LILLINGTON:
UT / , _\ 71-J L .t. G' / .1 /✓Ji/
POSED USE:
Sg. Family Dwelling (siu�x 2vb # of Bedrooms #Baths 3. S Basement (w /wo bath) Gaag9 Dcck
0 Multi- Family Dwelling No. Units No. Bedrooms/Unit ``'/
0 Manufactured Home (Size x_—) # of Bedrooms Garage Deck I .l �, / , /Y ""/
Comments:
Number of persons per household
O Business.. Sq. Ft. Retail Space
1i
Industry Sq. FL
Home Occupation (Size x_) # Ri
Accessory Building (Size x_) Use
Addition to Existing Building (Size x_)
Other
Use
Type
Use
Water Supply: /U� County U Well (No. dwellings ) U Other /
Sewage Supply: New Septic Tank iJ Existing Septic Tank County Sewer (_)
Erosion & Sedimentation Control Plan Required? YES NO
Cam. � -ltd' D
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 Win five hundred feet (500') of tract listed above? YES O
Required Property Line Setbacks: Minimum
Front /
Side
Actual r Minimum Actual /
Rear /
y / Comer
Nearest Building
If permits are granted 1 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 ture of Owner or Owner's Agent Date % #
"This application expires 6 months from the date issued if no permits have been issued CPU-/-
A RECORDED SURVEY PLAT AND RECORDED DEED ARE REQUIRED WHEN APPLYING FOR A LAND USE PERMIT
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