LAND USE Initial Application Date: / Z — 1] w Application # /p 5 Z ^ 76
DRS CU
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting 108 E. Front Street, LillIngton, NC 27546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.harnett.org /permits
LANDOWNER: 7 4 'Oivr 1 l 1') [ n ^�� Mailing Address: P( ' affil S7�%S4,
City: P r!'Ail 1 ( j State Zip: O Home #: Contact #: . QJ W _ e r
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APPLICANT': fl" T) R 1.( ), S 1` �'L.2 -� Mailing Address: r� - S � �U ��
r City: State: Zip: Office #: Contact #:
'please fill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: s. I/l.A._.■ Phone #:
PROPERTY LOCATION: Subdivision: / 4 %nom/ iA. Lot #: / Lot Size: 2, 39,
State Road 1 #: tate Road Naania: f� � '7 / M LI app &Page: 79, 57-'17
Parcel: 0/ 00 3 L A/ /� PIN: (S� - / 7 / 9 - — 7d , v''O
Zoning:_ Flood Zone: Watershed: /V �/ L Deed Book &Page: (Yr / 77 Power Company^:
New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
7 0? 7 ea/ 0 -- -
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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
❑ Indus Sq. Ft. Type # Employees: Hours of Operation:
❑ urch Seating Capacity # Bathrooms Kitchen
`-
Accessory/Addition /Other (Size. x��)Use Sj, 2 i-' n VR✓1C
Wate upply: County ( ) Well (No. dwellings ) MUST have operable water before final
Sewage Supply: ( ) New Septic Tank (Complete Checklist) (_J Existing Septic Tank (Complete Checklist) County 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 stale that foregoing statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false intormation is provided.
Signature of Owner or Owner's Agent Date
"This application expires 6 months from the Initial date If 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
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