LAND USE R Initial Application Date: Application# 1 ll .5C C :(1 I-1 1 ' `
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COUNTY OF NARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Ullbgton,NC 27546 Phone:(910)993-7525 ext:2 Fax:(910)893-2793 www.hamel.org/petmits
nA RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REWIRED NEN SUBMITitNG A LAND USEAPPLICATION'.
T EA-200C' 127 r t C'( r�/
LANDOW R'/` p1 i m M � {�' �-7 - MelYnp Address: 1� 4s`t✓ �.�/1 �'l �� ��
City: �1. 6JJ ,�1 State:JCrAZip:/ I'52CoLtact No: Email:
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APPLICANT*: / ' d K e- L 4T I j C N 1
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City: �"C'ii StaWJ:/VC Zip�ontacl No:�✓1`foaa Email: ' iiiT i, u
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CONTACT NAME APPLYING IN OFFICE: ' - Phone# ? / '�
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PROPERTY LOCATION:Subdivision: AAJ tl/ I 1 e[ 1 A ( I weep CC( Lot#: Lot SSize' rl /
State Road# )1 C�7 State Road Name: L / L) l/(j Map
p: yB/Pape:7k.' / L
Parcel / in - ci r 7 • c I . PIN: L )! NC
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Zanrp:j - .l Flood Zone: Watershed: IV A Deed Book 8 Page: /v/L. �`��PPower mpany:
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'New structures with Progress Energy as service provider need to supply premise num., LL C . / �� from Progress Energy.
POSED USE: (-0-0 1 — —
�/ ��/ 7 Monolithic
SFD:(Size�l.!xL ikh-#Bedroomsf#Beth/�esement(wisvo bath) Garage: Deck: 1 Crawl Spare: 1/Stab'._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(wAwo bath)_Garage:_Slte Bull Deck:_ On Frame_OR Frame_
(Is the second floor finished?(_)yes (_)no Any other site built additions?(_)yes ( )no
❑ Manufactured Home:_SW_DW TW(Size x )#Bedrooms:_Garage: (site buil?_)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: Bounty _Existing Well V New Well(#of dwell/cgs using well )'Must have operable water before Rnal
Sewage Supply' New Septic Tank(Complete Checklist) _Exisfing Septic Tank(Complete Checklist) _County Sewer //
Does owner of this bad of land,own land that contains a manufactured home within five hundgad feet(500')of tract listed above?( )yes (i7 no
Does the property contain any easements whether underground or overhead(_)yes (� )no
Structures(existing or Proposed):Single family dwellings: 1/l/I C Manufactured Homes: Other(spedfy):
Required Residential Property line Setbacks: I Comments:
m nts:
Front Minimum ^ `
.:- )) Actual Y. / Ito 1
Rear b J V
Closest Side Ili ' 1 I 0 L/
Sidesbeet/conrer lot Z-C
Nearest Building Il,
on same lot
Residential Land Use Application Page 1 of 2 03h1
APPLICATION CONTINUES ON BACK
DI
TIONS yo THE
SPECAFIC
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If permits are granted I agree to conform to all ordinances and laws of the Slate of Nath Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoi tementtsFareAar�, rate a correct ttootl)e best of my knowledge. Permit subject to revocation if false Informafion S provided.
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Sire re of nary Ow es Agent ate
"1t is the ownerlapplicants 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 mining Information that Is contained within than 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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