TOWN INFO TowN of LILLINGTON
"
- ZONING PERMIT
*
Planning & Inspecibra Department
t05 West Front Street Po Box 296 LIIirgton I C 27548 • phone 810-893 2554 *fax 910-893 -3893
Required Attachments: Submit a site plan showing the driveway, streets, parking, open space, sidewalk, utility lines,
major landscape features, and any existing and new structures) located in relation to the lot lines.
Name of Property (�
Applicant Io., -
, / Z q. ,, �c.,o1r„C Owner �• 'ie....A A,, rt4Ie
Address e> L1 l-4 I M.-ii I> Q,- Address /0 . d ke: h H . f j .
City /State C r- n..) C_ City /State L 11 . \. ,v . c . D 3 LI Ic.
/Zip ,a -, -, e y /Zip
Telephone 4'Iq _ Li I a - 8 a 44o Telephone 9 _ 5,:i.3_ S 9 4 .
Email ^ f Z ®. ¶0 kn it .� Email
Property Address: What are you requesting to build Does property access DOT road?
I u 1 's . M c.-: ..r Si- / what is the proposed use of the MKS
j�, 1 1 ; _ lov ti, c a -15 `1 L property? Be specific. rc ta Number of dwellings / structures on
C / 4 .. 7 Y 1 c_cc , r e� < le, y the property already: 1
Parcel Identification Number(s): Gott • R e.:. „- .. -.1_1 b,_y , -5/0,-).3) Property / parcel size: . c'
tr1.Md Co- otea a ,,
C7 (0 5 0 S a- / 6 a b s `7 Lot number(s):
Owner / Applicant Must Read and Sign
AFFIDAVIT: The undersigned property owner, or duly authorized agent/representative thereof certifies that this application and the
foregoing answers, statements, and other information herewith submitted are in all respects true and correct to the best of their
knowledge and belief, WITH THE UNDERSTANDING THAT ANY INCORRECT INFORMATION SUBMITTED MAY RESULT
IN THE REVOCATION OF THIS APPLICATION. I hereby authorize the Town of Lillington to review this request and conduct a
site inspection to insure compliance to this application. I also understand that this Zoning Permits will expire six (6) months from the
date of issuance, if the permit is not acted upon.
A S . Z ,t--' 1t �t _ Oci [5-i??
k-nnt rwame Sign f Ow o r Representative Date
FOR OFFICE USE
Zoning District: Watershed District: Is property located in floodplain
Q v {� ❑ Not located in one acco t to the FEMA map?
J ❑ Cape Fear - Critical No ❑ Yes
Front Setback: A Cape Fear - Protected (���` O
Side Setback. N, - Exempt from Watershed Regulations? � in U1
❑ No, more than one acre of land Planner's Signature
Rear Setback: will be disturbed throughout entire 09 - 15 0
(including phases) project area. Date
,G Yes, Tess than one acre
FAX TO FIRE MARSHAL'S OFFICE: (910) 893 -5025 & NCDOT (910) 437 -2529
trace ; Harnett County Fire FIRE MARSHAL'S NOTIFICATION
S ys " Marshal's Office RBOIBTRATION OF INCOMING BIIBnrts88
a hn ew"
Office (910) 893 — 7580 FOR THE TOWN OF LILLINOTON
Fax (910) 893 - 5025 Planning & Inswing Department
105 West Font She* Box 296 Langton NC 27546 • phone 910-8932854 .lax 910893 -36
(Please Print) (�
Name of Applicant: (n �-1 2 A •A.J 10. 4 CA k
Name of New Business: IV j L hod L,,,al GoL I . c, LA— 1) 1,A / 1 e < 5 o „ Ms,w 54 reel
Physical Address of the Business: /v r S ir
City: j—.' I �� ti .( ZIP: a - 7 3' a 6
Billing Address: , ?o` . full, fry » 0,. �� et-1 e- a7S / c
Telephone Number. (`+ 7) ` 1 1 d - h 5.6 Fax Number: re) W I uI - S i'-)
Email Address: - 4 u.1/4.7 7 @ N e ; r L b e i`ut:O - n /o+'K c. L A -
Owners Name: (sA4L1 2R^' Ccirc J c)
Owners Address: 2 , o i I t- ' I s M: Jr (2. (0,,.. c 7 r 5
* Is the Building changing occupancy classification?
* If occupancy classification is changing new plans must be submitted to Harnett County Central
Permitting (910) 893 — 4759 I
State type of business or occupancy applying for: r . ' \ -. c 104 bl • re 5 c fee (,,, /J ' ('T ca— .. e k/
d y.^, � , az.l r� 7 �1�../�. 9e,
Who was the last !mown owner of the building? S n ,: -1 A . , - 44
What was the last (mown business name? rl 2 /'1 e ' S ,', M c • ' I r ec
* Has the building been vacant for 30 days or more? N
* Will the building be renovated?
* Is there power and water to the building? y e
* I understand that I must comply with all applicable code requirements of the Town of Lillington and Harnett
County.
f � '
Print Name Signature ' • Per Representative Date / /