LAND USE R r t l l—1 'j��j
Initial Application Date: 014/ l - Application# 11 5W t-rd\ 5 in c?.....,
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l COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 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 REQUIREDWHENSUBMITTING A LAND USE APPLICATION"
LANDOWr\
NER fl U�) dr a (�(1../ ►
,1i Mailing Address: '%0 IVB— t, 53
City: W� State&-' Z :PC (Contact No': `[+))00-N'`-4--1 Email: `f--i- 'tvi LU 13Lf2,6yi.r-kr,
APPLICANT*:ekiN tAt.L -r(..1 1 L.l-a. Mailing Address: ',---301-0\ ---
City:
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City: State: Zip: Contact No: Email:
*Please fill out applicant information if different than landowner
ONCONTACT NAME APPLYING IN OFFICE: it (....\,hd.at( Phone#" i tO WO O—t 0`-C q
PROPERTY LOCATION:Subdivision: iNn f 4,1 1 i)1 ,00 Pi-per 14.4 c^,F/"i 1 in A '1 t �E P-11'6 Lot#: 49` Lot Size:I.,0 Ct
State Road# State Road Name: j; 1)Q .'-1
-/ Map Book&PageIA/ .1
Parcel: Q r\ 50°1 QCA_O(-1C3`g. PIN: 1�O i l�Lp-- 1 7 ,C.5T
Zoning: 0 Flood Zone: XWatershed: '^I"0 Deed Book&Page:;394
IC?-t 3 i l(i C Power Company*:
*New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
`"]7� Monolithic
SFD:(Size(06 x-11))v)#Bedrooms: #Baths:a_Basement(w/wo bath):_Garage: V Deck:✓ Crawl Space:_Slab:_Slab:_
(Is the bonus room finished?(_)yes (4/5 no w/a closet?U yes ( )no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms_#Baths_Basement(w/wo bath)_Garage:_Site Built Deck:_ On Frame_Off Frame_
(Is the second floor finished?(i yes U no Any other site built additions?U yes ( )no
❑ Manufactured Home: SW DW_TW(Size x )#Bedrooms:_Garage: (site built? )Deck: (site built? )
U Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use: Hours of Operation: #Employees:
Addition/Accessory/Other.(Siz x 4 L)Use: Closets in addition?(_)yes (___)no
Water Supply: v//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 o
Does the property contain any easements whether underground or overhead U SG)no yes lVVV
Structures(existing or proposed):Single family dwellings: Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks:, Comments: ` U�042;--
�� �1 ±v I^I�IJ�A--) '/
Front Minimum Actual 1 0 Q vs$ 4 2-- — f -#' 1 fl � c
�,jC 1 AT
Rear 1-1 `�
C t
S
Closest Side 3' •
Sidestreet/corner lot
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
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SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
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 foreoing statements are accurat nd correct to)he est of my knowledge. Permit subject to revocation if false information is provided.
, y• rip, 411 n f , Ci 1C;-I -I�1
Signature of or OYvner'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 03/11
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