LAND USE RRR Z " 11 10 I� '10 1 2E o ti'>oo° ic3`a
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, Initial Application Date: ' LQ J (� / �• O ?5 c c `391 /s1
- - Application # I 7
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"r" r 1 ' " CO OF HARNETT LAND USE APPLICATION
Central Permitting 108 E. Fron Street, Lillington, NC 27546 ., Phone: (910) 893-7525 Fax: (910) 893 -2793 www.hamett.org
LANDOWNER: SCk ( t] tJek )a IJ.nJj c n C. / Mailing Address: It O.. R ' 1 (60 '1
City: 61 t State: MC - zip: fr Home #:9.(9- -- }13 Contact #:1111 > I3q
APPLICANT: 5.k ; ) f - 0 Al Mailing Address: (pv+ -C. C (' C L J .t_
City: State: Zip: Office #: Contact #:
'Please fill out applicant Information it different than landowner /n� ` A
CONTACT NAME APPLYING IN OFFICE: - cad-0 y I. -`Cu fb8' (7 Phone #: 1 ( S - 't' 5 -- / ( (
PROPERTY LOCATION: 5 bdivision: -- Lot Lot #: 1. Lot Size: 3 ; 9 S PI C_
State Road #: y � ' 1 . 0 yak/State Road Name:, aL k (n.l¢ - Map Book &Page: l)(1 / 3 r L(
Parcel: ' , /� �, • ( �R Q I S 1 )� L i i i , () 1 PIN: 9 S � 1 S l I7r0, 0 3
Zonin RP02061 Flood Zone: X Watershed: I I \-- _ . DDe � ed Book &Page: () ILI 1 a 1 n 1 -0).
SPECIFIC DIRECTIONS TO THE PROPERTY FROM ULLINGTON: T;r, +.), L • it rt y/CN.) J ijc r e - SUwI {•
• 64. rc • R 0a. , n/ ..)- t0 .a • /� _ A L-L
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.-/ nit,,- • ?441 ' IdI CI) i5 (n l I 5¢_ 44v“_» Vii s•'i /t.
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PROPOSED USE:
t ❑ Multi -Family Dwelling No, Units No. Bedrooms/Unit
❑ Business Sq. Ft. Retail Space Type k \N k's# Employees: Hours of Ope tion:
ycoolers .- # Afterschoolers -)c � Employees � G� Hours of
^��' ' Daycare #Presh Operation � Gann (--# P ✓rl
❑ Industry Sq. Ft. Type # Em�plo a �Hours
. , v r " ❑ Church Seating Capacity 4 Kitchen v g
'' Accessory/Addition/Other (Size 1 f 0 x?S 1 Use j D co , _ (31.):1 CD (Y3 1
Water Supply: ( County (_-) Well (No. dwellings ) MUST !lave operable water before final { � n1 =1 �
Sewage Supply: L0/New Septic Tank (Complete New Tank Checklist) (3 Septic Tank (J County Sewer \ c. \4 (_,& ✓ e
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C Comments: I.,L 't y‘ri"l'•\1.0— .- t 11 C 1 0'4
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/ if p _ g ran n / • I ee t• •n'• 7 0 all anc a • l ai�`a'of the Stet: • i o arolinareg toting su work and the specifications of plans submitted.
I h:: • to that foregoing statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
- Ignature of Owner or Owner's Agent Date
•'This application expires 6 monthe from the Initial date R no permits have been Issued**
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
Please use Blue or Black Ink ONLY
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