LAND USE RR ' o 1�' 000 131`73(OCT CA2)
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Inxal Application Dale:ra rte Application # Cgs -- .5 00 - 15 19 L '9)(1-
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
• Central Permitting 108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 n www.harnett.org /permits
LANDOWNER: ' TAM t Moen 6 ec 1 Mailing Address: j /7 1440144(1 tit d
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City: Fdyla . ^ VVa n.,4 / , tate:4'd. Zip: May Contact # 669 - 77/1 Email: da wJtego ui /ea flI/ L O4leS /AC [p
APPLICANT: al/a (121211 // AM 14 $ %f Mailing Address: 61/7 £ 4 , -, CC /'rs t
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City: FF - II /ef ae State: /VC Zip: 7.75((0 Contact 1( ng19 6 10 9 - 7999 Email:(dC1u.�P
'Please fill out pplica t information if different than landowner /�
CONTACT NAME APPLYING IN OFFICE: //d /I 4, an., i �1 Phone # - (,b9 - 7 499
PROPERTY LOCATION: Subdivision: lC/ 0 /C S 7 "LC N14015 0{'it 2 Lot #: '7 Lot Size: 9. 2Y
State Road # P.15 State Road Name: 4 9 1 57 - OA c /AA 1 ✓ t M a p Book &Page: Z /1 9
Parcel: 0 - 04, 3S o05 OS PIN: O(71 ,. O}`(_ I (n ct O . 0 00 Gw�r a �
Zoning: 1' Flood Zone: X Watershed: ji I A- Deed Book &Page: 71 (0 3 t 1 (0S Power Company': Proof "'Ss
'New structures with Progress Energy as service provider need to supply premise number / / from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM ISLINGTON: 1/41/ lo C 0 n S rim 4 Lt, h r
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PROPOSED USE: j
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9ATi Monolithic
0* SRI (Size 58 x2) # Bedrooms:(# Baths:a Basement(er'wo bath): Garage: /' Crawl Space: Slab: Slab:
(Is the bonus room finished? /) yes (__)no w/ a closet? (_) yes (Z)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? (_) yes (_)no Any other site built additions? (_) yes (
❑ Manufactured Home: 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 (ono
Water Supply: V County Existing Well New Well (# of dwellings using well ) 'MUST have operable water before final
Sewage Supply: V 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 ()4no
Structures (existing or proposed): Single family dwellings: 1 t"° f Sr1c1c Manufactured Homes: Other (specify): Iea Der G -
Required Residential Property Line Setbacks: Comments: CQ2rC'EL Ct4Ar15€O 5tit. t (-D c - 10r OF rf00;
Front Minimum 35 Actual X51, 5 `� "amcrkito C1a244R W (es (2-W fiE. Coif 4 /13 b /z - IOC )
Rear ZS 1 41 5' 2-in I11 C.7S-r0. -�44 ecka,0 � S t fj h1AA,'T1ort T o �,/ 114". k- 'f
Closest Side ) O 2 75, 5 gcVr^ I
bS vg-E , > CFia-v- W f ``� 1 Co € li /
Sidestreet/comer lot 2 - C 1W//L/
Nearest Building CA 251
on same lot
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 stateme / rj I�� , are accurattq.4d correct to the best of my knowledge. Permit subject to revocation if false information is provided.
Ana re
ature of Owner or Owner's Agent D a
"This application expires 6 months from the Initial date H permits have not been issued**
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
Residential Land Use Application Page 1 of 1 10 /10