commercial land useInitial Application Date: 1 �! 13 )_
Application #
DRB # CU # "C-U° 3 / °13
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillingt , NC 27P46 Phone: (910) 893 -7525 r_Fax: (910) 893 -2793 www.harnett..orrg /permits
LANDOWNER: Z-a Mailing Address:/ -/ 3 0 L) �' �% /t Yis )e
ity: Ir/lJ �r!`� Statvv--6—,Zip:2�ontact# Email:
APPLICANT *: f3J L% Mailing Address: �QJtr
City: State%VL ZieW -1 Contact # Email:
*Please fill out ippfIcAnt information if different than landowner
Phone #JeQ
CONTACT NAME APPLYING IN OFFICE: � s
PROPERTY LOCATION: Subdivision: 42 i✓ Mi Lot #: Lot Size:
State Road # State Road Name: I k1 Map Book &Page: /
Parcel: PIN: I o
Zoning. mlood Zone: Watershed: t1A Deed Book &Page: I / S5 Power Company *:
*New structures with Progress Energy as service provider need to supply premise number
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
from Progress Energy.
PROPOSED USE:
❑ Multi - Family Dwelling No. Units: . Bedro ms /Unit:
Business Sq. Ft. Retail Space: type: # m�ployees: �_ Hours of Operation:
Daycare # Preschoolers: # Afterschoolers: # Employees: Hours of Operation:
❑ Industry Sq. Ft: Type:
# Employees: Hours of Operation:
❑ Church Seating Capacity: # Bathrooms: Kitchen:
❑ Accessory/Addition /Other (Size x ) Use:
Water Supply: County Existing Well New Well (# of dwellings using well ) *MUST have operable water before final
Sewage Supply- New Septic Tank (C mplete Checklist) Existing Septic Tank (Complete Checklist) County Sewer
Comments: 7
If permits are granted I agree to conform to all ordinances an la of the State of North Carolina regulating such work and the specifications of plans submitted.
1 hereby state that foregoing statemen are accuratg an or ct to the best of my knowledge. Permit subject to revocation if false information is provided.
Signature o Owner or Owner's Agent Date
* *This application expires 6 months from the initial date if 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
Commercial Land Use Application Page 1 of 1 08/10