LAND USE R Initial Application Date: 11 I r 4 Application# 11 5 r 0-121C-1q
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\k I rs I BOUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 1013 E.Froth Street,Lillington,NC 27546 Phone:(910)8937525 ext:2 Fax:(910)893-2793 www.harnettorglpermits
''A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)8 SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION'
LANDOWNER. =S qc C'IC
rt [ R rt/o if if erro Mailing Address: 2-g
1-g/7n&('f! meth C'vc LL 4Spr.ns Lc/ce Me.. ?53?o
City: State: Zip: Contact No's'I1l,''vl! 2' 7 Tl mail:
APPLICANT*: l(CIL�IInn Mailing Address:
City: 5Q(•vt0 p'.GifQ-t State:f C.Zip:2c7l Contact No: Email: _Y' D
'Please I out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE:. 'LII A I �/ (� I D\ `/7' /,C.
Phone#
PROPERTY LOCATION:Subdivision: V)/U( 1 � ( la pLJ`Iµ ) 8-) I ;X` . I Lot#: 51 I Lot Size: �J
State Road# I I rrrn�q II State Road Nam/e:' n r(( �4u,( 1 '�L ' , /` Map Book 8 Page'. I / I / I
Parcel: I ' .5`i--1 ' l 0 Lo C L PW 95i 1 -' � .C . 5L%
`/
Zoning: �� oo Zone: F Watershed: Iv A Deed Book Page. alD Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Size l#Bedrooms: #Baths:_Basement(w/wo bath):_Garage:_Deck:_Crawl Space:_Slab._Slab:_
(Is the bonus room finished?( )yes ( )no w/a closet?(_)yes (_)no(if 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
Ijr Manufactured Home. X SW_DW_TW(Size 1/{ x ft) )#Bedrooms: 3 Garage:NO(site built?_)Deck'.Jy(site built? )
1
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
O Home Occupation:if Rooms: Use: Hours of Operation: #Employees:
❑ Addition/Acces ry/Other:(Size x )Use: Closets in addition?( )yes (_)no
Water Supply. County Existing Well New Well(#of dwellings using well )'Must haven ruble 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 (V )no
Does the property contain any easements whether underground or overhead(—)yes (_)no
Structures(existing or proposed):Single family dwellings: Manufactured Homes: 1 Other(specify):
Required Residential Pre erty Line` (Setbacks: Comments: C`d(^'f`
Front Minimum ) Actual '�J \A y VL_l�� —a coil a
Rear I -,{I •
Closest Side I U
/ I
Sidestreevcorner lot I C
Nearest Building I 0
on same lot
Residential Land Use Application Page 1 of 2 03111
APPLICATION CONTINUES ON BACK
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SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
Sig 26irney c. - SQnu9 (a(4 AJC 2$''39d ('\- jjv, •LAcs
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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 accurst .•• a rred to the best of my knowledge. Permit subject to revocation if false information is provided.
a.%
Signe ure 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'•
Residential Land Use Application Page 2 of 2 03111
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