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Initial Application Date= � {9 Li —�DATE willtee' Application# (515(1.)1C)/' c4 3
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COUNTY OF HARNETT LAND USE APPLICATION 'F�+' '-
Central Permitting 108 E. Front Street, Lillington,NC 27546 Phone.(910)893-7525 Fax:(910)893-2793 www.harnett.org
LANDOWNER.T / ,iu
f90 ateiC(owl it of-#16.. (arvinAC, Mt. Mailing Address: Q. 0 . 6[4. IZSL-}L4-
city. 2nlel k state: NC- zip:2-71/V; Home#.4SNG)C3?.. taDt# C1 1 q lc 3 a-04 I
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APPLICANT': Mailing Address:
City: State: Zip. Office#. Contact#:
'Please ell out applicant information ii different than landowner
CONTACT NAME APPLYING IN OFFICE: Phone#:
PROPERTY LOCATION: Subdivision. cpx;n(„ MI I! /'lc/&lJ h-IA I Pa✓k Lot#: q Lot Size. 4•1419 73 A(_
State Road if: No State Road Name: Pa me la- CON✓f Map Book&Paget 5774 > SSS/J
Parcel: d ' Q4 OH a Del PIN: 0(05`1- S7-0/ 0/. cc,
Di strp c+
Zoning.14(44illetI Flood Zone. X Watershed'. H Deed BookePage.DI 183 ! o3i ?
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
/—)L)I N o v—Wi —hi P(Cr)11C I C C--1-.
PROPOSED USE:
❑ Multi-Family Dwelling No.Units No.Bedrooms/Unit
❑ Business Sq. Fl.Retail Space Type #Employees: Hours of Operation:
❑ Daycare #Preschoolers #Afterschoolers #Employees Hours of Operation
X Industry Sq.Ft. .ib 0O Type Sin') #Employees: Z Hours of Operation:
❑ Church Seating Capacity #Bathrooms Kitchen
❑ Accessory/Addition/Other(Size x 1 Use
Water Supply: Jcaunty (J Well (No.dwellings _) My`�$/T have operable water before final
Sewage Supply.#�1New Septic Tank(Complete New Tank Checklist) y�Existing Septic Tank ( )County Sewer
Comments: D IS a ; . A. -eQ7\ `i1
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If permits are granted I agree to conform to all ordinances and laws of the State of Nodh Carolina regulating such work and the sp- i MSO an6 Nab
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.
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Signature of Owner or Owner's Agent Date
"This application expires 6 months from the initial date if no permits have been issuer"
A RECORDED SURVEY MAP,RECORDED DEED IOO�RR/OFFER
/TOO PURCHASE)/URC `/ AND PLAT ARE REQUIRED/ WHEN APPLYING FOR LAND USE APPLICATION
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