LAND USE Initial Application Date: d 1/ - /4 / /
Application* /t 2 / Th
CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.hamett.org /permits
LANDOWNER: vt (A rd d d Xnie\ 1C_ 1\1 1 (7)10 .,,/ Mailing Address: /OS f o` Srs t \ Or VC -
City: City: AYIia t GY' State: NG Zi p: c2 contact #c11O - o ial - t 3} Email: i>NICOI..IkV�/L I40.(1.
APPLICANT': Sv/N (. Mailing Address:
City: State: Zip: Contact# Email:
*Please fill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: 5pLCC, Phone #
PROPERTY LOCATION: Subdivision: Pct )\' YY%r' ?O i . r. }C. Lot #: C Lot Size: 0 • S 0 : 1 --' c '
State Road # State Road Name: 1 \ Dr 'N T- Map Book &Page: ,2CJOaI S
Parcel: 0 + 6 (91 3 h 13LE- O 4/4 /q PIN: (Xo (v 3 - c�
3- a I Sol
Zoning: R A Flood Zone:./ Watershed: / Deed Book &Page:02t lO /6,75q Power Company`: t(D , - a_ h
r
New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM ULLINGTON: 210 N At ) JU.rrra -S 1)..)01n
01 n b 1 2_,t c- Y,, ,
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PROPOSED USE:
Monolithic
❑ SFD: (Size x ) # Bedrooms:_ # Baths:_ Basement(w/wo bath):_ Garage: Deck:_ Crawl Space:, Slab:_ Slab:_
(Is the bonus room finished? (__) yes (__)no w/ a closet? (, ) yes Lino (if yes add in with # bedrooms)
❑ Mod: (Size x ) # Bedrooms # Baths Basement (w/wo bath)_ Garage:_ Site Built Deck:_ On Frame_ Off Frame_
(Is the second floor finished? ( ) yes (__)no Any other site built additions? (_) yes ( )no
❑ Manufactured Home: _SW _DW _TW (Size x_) # Bedrooms: _ Garage: (site built ?_) Deck: (site built ?_)
❑ Duplex: (Size _x ) No. Buildings: No. Bedrooms Per Unit:
❑ ome Occupation: # Rooms: / Use: Hours of Operation: #Employees:
Addition/Accessory/Other: (Size t ` x Z f) Use: P) on i )> ear----- Closets in addition? ( 1 yes (Jno
W r Supply: X County _Existing Well New Well (# of dwellings using well ) *MUST have operable water before final
Sewage Supply: New Septic Tank (Complete Checklist) Existing Septic Tank (Complete Checdist) _ County Sewer
Does owner of this tract of land, own land that contains a manufactured home within five hundred feet (500 of tract listed above? (i yes (4)no
Structures (existing or proposed): Single family dwellings: E Manufactured Homes: Other (specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum 35 Actual
Rear 2S
Closest Side /
Sidestreet/comer lot 0
Nearest Building
on same lot
If permits are granted 1 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 -. •'ng statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
1.. i r . a _ - ( / 0Gl - I o
Signature of Owner or y nees 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
Residential Land Use Application Page 1 of 1 07/1D