LAND USE R k��1 SIan x/ 1 \ / LI .Initial Application Date: 1. / V / I V Application k 1 S ' ✓cn i I . Tl"I J
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)8934525 ext:2 Fax:(910)893-2793 www.hamett.org/permits
'A RECORDEDn1SURVEY MAP,RECORDED DEED(OR OFFEROTO PURCHASE)8 SITE PLAN ARES�RREEQUIR(EDD WHENENSUBMITTINGBMnA�LAAND USE APPLICATION.'
LANDOW/N�EER::k1NAYQc, TWDIA 1 Q/V3\C.\&L/ Mailing Address: O9%\ L�1/1��AOt�IA I'F�X ✓Id
co: Ll A1,n^yQV�Oh Sta(Ite A��l�ryZ�i(p .Y:ItpContact No: II U' I�I 11DI\�% lU Em sit
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APPLIC (N(`�T�yI::��A��IdVQG I�ijbQl SAIIl��t1 IJ1&ryM`aa0iiIiqnng'��AIddress: St V4q 1.A1t 11 �\Q.- y'
City: J.AIV.A.1I Stated/ ZipaNG Contact No: /I O' IIID 11 /l1„1 I Email: !#'
Please fill Out applicant information it different than landowner
CONTACT NAME APPLYING IN OFFICE: cl �j pyp /�n� Phone k
PROPERTY LOCATION:Subdivision: A /: (W ( Ill1"L`w"`i /x_]/' Lot U: Lot Size: a_
State Road k- State Road Name: s I L U' - Map Book 88PPaage'AMI/ �
Parcel'. - °MX, CO 3 I PIN: Sr MEI . c IJ ac — j
fpr
Zoning:W WaW' •Zone: l'- Watershed: /V/v Deed Book 8 Page,, 2/ l- /4 •ower Company` r
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SR):(Size x )#Bedrooms'._If 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 k bedrooms)
❑ Mod:(Size )#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
E Manufactured Home:_SW 4W TW(Size/Lx 50 )#Bedrooms:3 Garage: (site
built?_)1Deck:_(site built? )
1:1 Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit: x: 1�`vC'
❑ Home Occupation:#Rooms: Use: Hours of Operation: /�/\ ,�� t( i#E'mp oyees:,W L
❑ Addition/Accessory/Other:(Size x )Use: ��J losets in addition?(_)yes _ no
/e) V l '\ctn -c- A.0. _
Water Supply: County V 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 (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)'.
4C�S!/I
Required Residential Property Line Setbacks: • Comments: I )2 )
(7 �1. tiA
Front Minimum rJ --) Actual I �l �'+ � ) ( /y // /� � �/� �/1q ypc (/�A yy����yj�y�/�
Rear Cr) 1/ �l ld J� �/A`,).,6�L/.1�,� ]l�l.Lc ( "I �� ' C��� ' .'I Vh.`lam
Closest Side I 2C t 1 MA , CKIPC/l tc •C \Lit1_-.)
Sidestreetkomer let 2 ) � )ley/ �p �� A!' �hl�,ie. (_t�/./A�-,.l E� Y--' S
Nearest Building I �/ u (1C . Y �� :3/ C C/ 1 CAE(17
on same lot
Residential Land Use Application Page 1 of 2 L • 03/11
APPLICATION CONTINUES ON BACK
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 foregoin statements a coura correct to the best of my knowledge. Permit subject to revocation if false information is provided.
il Aft °I -I3—I$
Signature of Owner or Owner's Agent Date
mit 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 missing information that is contained within these applications."
"This application expires 6 months from the initial date if permits have not been Issued"
Residenlial Land Use Application Page 2 of 2 03111
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