LAND USE Initial Application Date: 8 — I — /!l Application # / r ?Cr /P
DRB CU
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillingtan, NC 27546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.harnett.org /permits
LANDOWNER: C.eol%14'c' -1 Cave li'-G, 14 Oka tin f Mailing Address: f 6 16 f - r ,LA oy Tows- Rd,
City: State: Zip: , Home #: Contact #:
APPLICANT': 5a w,flnt . Ket-al 5 aiIotLM C- C. Mailing Address: 1 ( L( Teo -w-wo-y (1/44, 5a,w'otoL IV
City: State: Zip: Office #: R 19? 16' ZG 2 -111 Contact #:
'Please fill out applicant information if different than landowner [ -2
CONTACT NAME APPLYING IN OFFICE: 9' O-\ PA -t't -€ r Phone #: q I9 .7 7 o Z 6 2-3
PROPERTY LOCATION: Subdivision: �,} . Lot # Y ' : Lot Size: / / 2 L.L.4--- I -
State Road*:
v� / / Stale Road Name: ft1 » Y` //ivy? Xi J7/ L p Map Book&Page: 2 ^�
Parcel: 0 q / 7 • r ✓✓. ? !/ 7 I / • PIN: 7 S ✓ 7 - jd - 4' ' '92 �c
Zoning: ,—J—+ Flood Zone: Watershed: . /i. Deed Book &Page: 7/ 1 P ower Company':
New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Ha( 23 -ro 30(.lv. Y t I le. -i- 2. - 7. 7 itkeiv,9'0
Cam, ovL 21 IEo.r -(- 3 w.ile; CAN powto M 'rusty- (may- Z dead
EtAd,s ot& Mr,i(,-,y (own P.A.
PROPOSED USE:
❑ Multi - Family Dwelling No. Units No. Bedrooms /Unit
❑ Business Sq. Ft. Retail Space Type # Employees: Hours of Operation:
❑ Daycare # Preschoolers # Afterschoolers # Employees Hours of Operation
❑ Industry Sq. FI. Type # Employees: Hours of Operation:
❑ Church Seating Capacity # Bathrooms Kitchen
❑ Accessory/Addition/Other (Size2.S x t{ 8) Use ` ' .a .2 L.G4j7 f
Water Supply: ) County 1 ) Well (No. dwellings ) MUST a operable water before final
Sewage Supply: (J New Septic Tank (Complete Checklist) Existing Septic Tank (Complete Checklist) ( )County Sewer
Comments: -- r 1 1 . -... 2D17 2-- ®l — 6 — g
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 hereby state that foregoiinformation ng statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false info is provided.
1 * s tfgi x-, if-10-10
Signature of Owner or Owner's Agent Date
"This application expires 0 months from the Initial date 11 no permits have been Issued"
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
Please use Blue or Black Ink ONLY
LAND USE _ 5/08
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