DOCUMENTS Initial Application Date: e/ 7 / i ' / Application# `11 ScC�'l►01
CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27548 Phone:(910)893-7525 ext:2 Fax(910)893-2793 www.hamett.org/permits
**A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPUCATION"
LANDOWNERUbe COP ) Mailing Address: -i -IS Roth Cr v{'e,
uq u&.9 Van not StateNL Zip: L1 5211tontact No: .513tirtg,JAI Email: t e la nnA) ca s@
APPLICANT*: t`i 1. 1
ny L Vj V Mailing
Address: V 1 N. ILAIL V
maltoni
Ciy: ooRsv it StaterGZp: 211l ContactNiOj30() f11aii: w&2�,( U
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'Please fill out applicant info If different than landowner � 00 r n
CONTACT NAME APPLYING IN OFFICE:1)RO G1� C Phone# Ui- Va0 'c i78O
PROPERTY LOCATION:Subdivision: .,Chi" 1 (,nUoc.) S Lot#: /4 Lot Size: L a
State Road*L4 IOJ State Road Name: l (1 (1�'� Map Book&Pageioot'rL)0 l / to a(.
ea
Parcel: b p c)LoS h ac t_09 PIN: c ..06 I - (Act - 4 S LIS • Y>(>
Zoning ,b.Flood Zone: X Watershed: A Deed Book&Page:3311 1/ Company*:
*New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Size x )#Bedrooms:_#Baths: Basement(wtwo bath):_Garage:_Deck:_Crawl Space:_Slab: Slab:_
(Is the bonus room finished?(_)yes L)no w/a closet?(___)yes L)no(if yes add in with#bedrooms)
❑ Mod:(Size_fit )#Bedrooms_#Baths_Basement(w/wo bath) Garage:Site Built Deck:_ On Frame Off Frame
(Is the second floor finished?L)yes (_)no Any other site built additions?L)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
O Home Occupation:#Rooma: Use: Hours of Operation: #Employees:
❑ Addition/Accessory/Other:(Size x )Use: C 5 #'W ILXSloasts in addition?
UYes Lno
9-11- 4 6. u4g2--
W: =r Supply: County Existing Well New Weil(#• ' . - ' , )*Must have operable water before final
S - upply: New Septic Tank • - . =7i/s() Existing Septic Tank(Complete Ch= .r• -• . _
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 property contain any easements whether underground or overhead(__)yes L)no
Structures(existing or proposed):Single family dwellings: Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum Actual
Rear
Closest Side
Sidestreet/comer lot -
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SP CIFIC DI CTIONS TO THE PRO RTY FROM LILLINGTON: ��V`" f Q�So f C 0 C '-/o n t
5 .� �ry r onto 6 . Main sfir
4 )t fliknr 0K.�y trii ( e -f- DittD US-La/N
n Rj h1- on .trd Poad
r 9 t onto Lldsr ll Iiitancifiv ofr .
-rur Le_ {'i" Or Ru-'n Qrc'u -
If
permits are granted I agree • •rm 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 • = n re a rate and correct to the best of my knowledge. Permit syp ect to rJevoc!]ation if false information is provided.
Sign ,f Owner or Owner's Agent D
"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"
Residential Land Use Application Page 2 of 2 03111
B1019 €. 1C C-t-v i co 1
Application#
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546 - Ph:910-893-7525 - Fx:910-893-2793 - www.harnett.org/permits
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner(s)of Structure: _b.LA (7I' {-e ('(t _ n
Owner(s)Mailing Address: / q A i' Phone: '�
� � fi
. lAi Ni 21 2
Land Owner Name(s): t V S
Phone:�aC( �i(o- (� ( (cl
Construction or Site Address: A
C 1 V C 1,
PIN# 5 - if -45/45- Parcel#
Job Cost:2. C)1 U Description of Work to be done
1 a Olit 011 s
Mechanical: New Unit With Ductwork New Unit Without Ductwork Gas Piping—Other
Electrical*: 200 Amp <200 Amp Service Change Service Reconnect Other
*For Progress Energy customers we need the premise number
Plumbing: Water/Sewer Tap Number of Baths
Water Heater
Saecific Directions to Job from Lillinaton:
. a . a arca 1-tame St urn L tin--v
� • • / viio US- t-lotN // r y
•A IA . ■. R it // o ,
Subdivision: i /. 0 0 d S
P e fis
t' tn i cot of Lot#:
191x.1 Ir�in�
I— r` C10 will provide the1�C\r r i C u 1 labor on this structure.
(Contractors Name)
Trade)
I am the building owner or my NC state license numberis 9 Z 60-7+-0
perform such work on the above structure legally. All work shall comply with the State Building Code and all
other applicable State and local laws, ordinances and regulations.
11°0W-C-Y iioYbrc SO G.r Ltd
Contractor's Company Name U(J v ( �
) i.Y1 011
r) Telephone
fi rVlo�I'esvi
Address t Ie blc�w� owet�!-torte ,c,uvt�
2(y U 7 y_U / 606P-Ho 6 0 6 - Email Address
License#
Structure Owner/Contractor Signature.' ', ,
'"� (k4IZAdJ'
By signing this application you affirm tr- •. have obtained permission from the above listed license holder to
purchase permits on their behalf. If•oing the work as owner you understand that you cannot rent, lease or sell
the listed property for 12 months after completion of the listed work.
*Company name, address, & phone must match information on license