LAND USE RRR i
Initial Application Date: 7�- . IF 4.I f l Application # 5 019 I 7,3 l / (2-if : r ' l -}' C. Y N�� (ORB CU
.. L COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting 108 E. Fro et, Liffin ton, NC 27546 Phone: (910) 893 - 75255 (+` Fax: (910) 893 -2793 www.harnett.org
LANDOWNER: SCA , `' at-71 4/47- 4/47- I ) n L. • Mailing Address: V O. Re: r10
City: ! t IV c. State: � C Zip :_ *j 6p Home #: 9(1- ` 5 8" - 1, 34 Contact #41'S ' 4 1 - � 13
APPLICANT*: Sa (; .P re,,n/r. .rda Mailing Address: fO✓r -L c f CL0 1 . 1 -
City: State: Zip: Office #: Contact #:
'Please fill out applicant information It different than landowner
CONTACT NAME APPLYING IN OFFICE: Zn t Y lA a`LL itrar C`7 d Phone #: i - 5 5 -- / p 6, c 5 ,
PROPERTY LOCATION: ( S / ybdivision: - ` Lot #: i Lot Size: 3. 9 5 / —
F la ) t(
State Road #: � 1 State Road Name: 'LJ y — 4.. a ` L 19. -y1
. Map Book &Page: 0 () / 3 / L(
Parcel: k Jga1S 7j (, 6 s /) 1 / PIN: 9S7 S �(Y3- rj'),'0, 0 0
Zoning: 1 Flood Zone: X Watershed: / �T . DDeed Book&Page: (J 14 14 / l) ��>.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Trl. r.rh L r //I q )?/ J - r
} .') jq r 7 Scums) J.
Su roc/ ., /..14-.c 20e;,� c/Z rt
,I A"...1-- 80 J 7 �s(
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-iv r, 71J- i3 ur1 6 IC1 /s t'k r4..C(( b 44, .:0$ l ief ni,ic_
a ti r•r f 1t. t -.
PROPOSED USE:
❑ Multi - Family Dwelling No. Units No. Bedrooms /Unit
.74., Business Sq. Ft. Retail Space Type t Xni 1 # Emplo es: Hours of Ope ation: "
Daycare # Preschoolers # Afterschoolers ` X •1># Employees Hours of Operation ( OS� eV\ - LS P (Y1
❑ Industry Sq. FL Type # Employees: , r :. • . COLE) . .
❑ Church Seating Capacity # Bathrooms Kitchen M0.4 • Q
Accessory/Addition/Other (Size 'tOx�S l Use `). \p a y_ ( ..t \2) r,
Water Supply: (�
...
County Li (No. dwellings ) MUST have operable water before final 00 ) + T
Sewage Supply: U New Septic Tank (Complete New Tank Checklist) ('Existing Septic Tank ( ) County Sewer
Comments: 0\ A . - 1
Cv5'ro. i. (+trick, a[.1•L >•7. EMS. A —i a,� - - - . • .. - -
(i o1 Jr-4fT -_ >LiJ
id- a - l a 37- "t c> t' i gtil-k ;Jr tx C .q ."tfrS 1-Win
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If permi = -e 7e gra I to -•n : - o all • • nand laws . th&te o North Ca olirfa ulating such work and the specifications of plans submitted.
I her: • y sate that foregoing statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
# ` i i?_� -n
Signature of Owner or Owners Agent Date
"This application expires 6 months from the Initial date N no permits have been Issued'•
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REOUIRED WHEN APPLYING FOR LAND USE APPLICATION
Please use Blue or Black Ink ONLY
9/07
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