LAND USE C Initial Application Date: ! / - Z Z — 1;/ Application # / o fff 2 5-K1 5- 7
DRB # CU #
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting 108 E. Front 1-
Street, Lillington, NC 27546 Phone: (910) 893-7525 ` Fax: (910) 893-2793 www.harnett.org /permits
LANDO WNER: V 1MSGL l iCi t GI ) � �� rr�� Mailing Address: , ^ � sc 4\t.J ) —2! � 1
City: GAl'Y` -D�J ` , S Zi,,--
tate4 ontact # \1 4 0D0 EEmail: \fvtcical�utn & rC
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APPLICANT': r r I 11 Mailing Address: IO a oX 1 ) l�. 3
City: 13rer, - c ) 4 1 A State: r vr_Zip: Z Sntact i 4i Y 3S - /C /Email:
'Please fill out applicant informati n if different than landowners 1 J
CONTACT NAME APPLYING IN OFFICE: Oc.X -f� I � �! Y 1 Phone ( 919 I 5' ,- ;S - 91-1- 1
PROPERTY LOCATION: Subdivision: Coro line. I r . 1Le-s Lot #: Lot Size: / ( b
State Road # of State Road Name: /n / Map 94-22,(2,90 BookBPage: _L /97/J/— B
Parcel: 1/ /A? NI Flood 7 9 4 1/,( 1 /OOO // ,�1 OCR g/ PIN: / 7 7 d S^ — G '7 7
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Zoning: A!` Z /?Flood Zone: /� Watershed: /Y/ A-Deed Book&Page: / l 2 ?Power Company':
New structures with Progress Energy as service provider need to supply premise number //J� from Progress Energy.
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SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: . 7 .J
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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. Ft: Type: # Employees: Hours of Operation:
❑ hurch Seating Capacity: #Bathrooms: Kitchen:
Accessory/Addition/Other (Size
�,px ?ra Use: Fh'�-r 1.).., I�
Wa r Supply: /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 Checklist) 17 Sewer
Comments:
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 foregoing statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
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' nature of Owner or Owner's 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
Commercial Land Use Application Page 1 of 1 08/10
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