DOCUMENTS Initial Application Date'. 10'Z Iii /W/VI�/1 `�"k Application I SW k/J-4
/LM//11 CU#
COUNTY OF HA OWiIAtEAN APPLICATION
Central Permitting 108 E.Front Street,/' ' ii C 27546 Phone:(910)893-7 5 ext Fax (91D)893-2793 www.hamett or / rermits
"A RECORDED SU1RVEY MAP,RECORDEDIDEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING ALAND USE APPLICATI C'ANNEI)
LANDOWNER:_ 1 )l Diet,\ aid Vee]C4f rpt(ulµMailingAddress. r2 t045 N.Q/A% 0X.Trio! Dr. OCT 01 1011
City: -cr-12 `L„ State: Zip. NC Contact No: qIZI-1�ri.1'16143 Email: "R IIGE I'1717 tL' u^/i.
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APPLICANT*: ( it V,� Mailing Address: J
City. State. Zip: Contact Ne Email:
'Please fill out applicant information if different than landowner
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CONTACT NAME APPLYING IN OFFICE:Rt Vlaf /3(( 1101 I Phone gIcf✓1✓!d /q 43 I1q 30419Iy
PROPERTY LOCATION:Subdivision: �.�p�/ NC. ^� Lot#: Lot Size: �y
State Road# State Road NameLJU'I l O(1 L' e Map Book&Page:b!(#1 d.1�Z
Parcel:(fin 1b{00 63.13 PIN: '(�o0-d1 wL]- DSYCo �
Zoning CW Flood Zone. Watershed I V V Deed Book&Page: 1(41 / W 1 Power Company'.
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
p q �, Slab: lh;c
❑ SFD:(Size)u)f x11'"1)#Bedrooms5 #Baths: Basement(w/wo batt' Garage'. Deck:_Crawl Space: Slab'. Slab'.
(Is the bonus room finished?( )yes (_)no wl a closet?( )yes ( )no(if yes add in with#bedrooms)
U Mod:(Size x )#Bedrooms_#Baths Basement(w/wo bath) Garage: Site Built Deck:_ On Frame_Off Frame
(Is the second floor finished?( )yes ( )no Any other site built additions?(_)yes (_)no
U Manufactured I-lame:_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
YY��Ldrno
Structures(existing or proposed):Single family dwellings. 1 QO ansflaclured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum ' S Actual
Rear
a2
Closest Side I O
SidestreeVrurner lot _
Nearest Building
an same lot
Residential Land Use Application Peso t of 2 03/11
APPLICATION CONTINUES ON BACK
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