land usere
Initial Application Date: Application # f
DRB # CU #
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting 108 E. Front Street, Lillington, NC 27546 Phone: (910) 893 -7525 Fax: (910) 893 -2793 www.hamett.org /permits
LANDOWNER: Mailing Address: g 33 b6GS t
City: . I ka%a State: �JC Zip:a95 Contact# Email: Mike,Ai JAmBricAfJ 1290 -AV* '1 t a G
APPLICANT *: S Mailing Address:
City: State: Zip: Contact #
*Please fill out applicant information if different than landowner
Email:
CONTACT NAME APPLYING IN OFFICE: JMIChii
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Phone# P !
PROPERTY LOCATION: Subdivision: 8A(—_ RQWPSki �
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Lot #: Lot Size: I CL L re -4
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Road Name: ba,S (G
State Road # rf /�f�
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Map Book &Page
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Parcel: /) -10509 00 LB PIN:
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Zoning: _ lood Zone: Watershed: Deed Book &Page: Q/ % /
6Y Power Company *:
*New structures with Progress Energy as service provider need to supply premise
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from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: 0 W.t
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PROPOSED USE:
❑ Multi - Family Dwelling No. Units: No. Bedrooms /Unit:
W'oo' Business Sq. Ft. Retail Space _Type: V e-&"%J # Employees: rl Hours of Operation: M - idt
❑ Daycare # Preschoolers:
❑ Industry Sq. Ft: Type:
# Afterschoolers:
# Employees: Hours of Operation:
# 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 (Complete Checklist) Existing Septic Tank (Complete Checklist) County Sewer
Comments: Au-s�,a9.2,5S rS --.e uio-J k3o N-st% moo_ ®a7
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 statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
Sfinature of 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, RECOFjDEID DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
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