LAND USE R Initial Application Date:3-r--20---1, y\ I I9 Application 11 )(7-\Li ) CCC) E21
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillinglon.NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 w.vw.harnett.orglpermits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)8 SITE PUN AREREQUIREDWHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER:J,rr1 01 /q y1,C vyC. Mailing Address: 0 W Mind S!.
City: b1/44/1 /` I J1 State:Ne �Zipip:2enr/Contact NNo: /�O '',�Z-S)Pl Email: �yM9 6 p
APPLICArNr�TTAJIZh ( atsfr(/1.h01 cat/ •-�YYiling Address: 201 4e. mbar) 4n, SC f rn
City: l/Un/1 State:yc Zip:2tW Contact No':9/-697-6905 Email: V!! 2�7�
'Please fill out applicant information If different Nan/landowner 11 I pyL �7 p,.
CONTACT NAME APPLYING IN OFFICE: L(,cr'a C. I11'1 IrAC(DY1 Phone /P7-PO-69 s rT
PROPERTY LOCATION:Subdivision: Iw/.V)OA/h(17D't& ,/ Lot#: Il Lot St e: Ir FI/
State Road# In State Road Name: C(Jr' IdmU Dfi✓B Map Book 8 Page: / ��l` 1&d_
Parcel: D7/VAZcocfII PIN: /b/O- 7t-I S6Y000 r
Zoning:DY,A1J
-7O Flood Zone: X Watershed: ' Deed Book 8 Page: / Power Company': 1/WP gist,
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolihm
SFD:(Size Sfr x1'l )#Bedrooms:3 #Baths:2ABasement(wMo
bath): Garage: 2_ Deck:_Crawl Space:V Slab:_Slab:_
(Is the bonus room finished?(_1 yes ( )no w/a closet?(_)yes (_)no Of yes add in with#bedrooms)
❑ Mod:(Size_x_)#Bedrooms_#Baths_Basement(wlwo 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:
❑ Home Occupation:#Rooms: Use: Hours of Operation: #Employees:_
❑ Addition/Accessory/Other(Size x )Use' Closets in addition?(_)yes (_)no
Water 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) _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?(_)yes (✓)no
Does the properly contain any easements whether underground or overhead(_)yes (lam no
SlmcWres(existln9 or proposed):Single family dwellings: I Manufactured Homes:
Other(specify):
Required Residential Property Line Setbacks: •� CCoomments� r� ,f \\ /�
Front Minimum 3 sr- Actual�u 7 1 /• / .& ( 5\ an -/v L„) I 'C a
Rear Z.r 2r#-
Closest Side /A -f to•
Sides/rest/corner lot 1/�
Nearest Building (- '-
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPEEsIFIC DIRECTIONS TO THE�rPROPERTY FROM LILLINGTON: Y7 I � TCw� NI ✓nA — `CAL 040
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If permits are granted I agree to conform II ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoi accurate and correct to the best of my knowledge. Permit subject to revocation if false information Is provided.
3-30-17
gnature of Owner or Owner's Agent Date
"'It is the owner/applicants responsibility to provide the county with any applicable information about the subject property,including but not limited
to:boundary Information,house location,underground or overhead easements,etc.The county or its employees are not responsible for any
incorrect or missing Information that is contained within these applications.'"
"This application expires 6 months from the initial date if permits have not been Issued"
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Residential Land Use Application Page 2 of 2 03/11
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