LAND USE RRR SCANN D
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Initial �
Application Date: b J (JU I"13� r + '
r ,( 1 8 Application #
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COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting 108 E. Fro Street, Lillington, NC 27546 Phone: (910) 893 - 7525 1 n
Fax tt.
Fax: (910) 893 -2793 www.harneorg
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LANDOWNER: .S4 y . f( 'J or4 1 j. 1J C • ,
P Mailing Address: " Il O. ! Si`• �C (n _
city: 6t tJc. State: !VC Zip ) ;& Home #: 9 il1- 958-113 Contact #414' a - al 3ti
APPLICANT": S a k r 4 ro.. Jr. fir-0 a Mailing Address: (tom C. 1' C 1:70 J I—
City: State: Zip: Office #: Contact #:
'Please all out applicant information if different Than landowner 1
CONTACT NAME APPLYING IN OFFICE: V- inQ 14 (Aret -L-+. Mytf (7 Phone # (i : - 75 $ -- / Ce 4 5 _
PROPERTY LOCATION: ( SJy C) bdivision: -�} — Lot #: 1 Lot Size: r ri C '
State Road #: y � �- yr 1 State Road Name : �l a /- (7 ` 1w/9 -y� Map Book&Page: 19 l 3 L(
Parcel: � V • . ('J�L S j O / 6 / S C) 1 PIN: 9 S -) S --- c � O 3 -+• j IS- , 0 3
Zoning: RA / � Flood Zone: X Watershed: (" t Deed Book &Page: C) IZ{ r7 n /a„?.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: frd . L r //r:t -O r/xlf. ,a- 7 Jtk. -1 1.
L U/le /Rjrr( o c: r) ch— ' /Ce fr0 }t) t 77 ry
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iu AT - , p..)- 014.) f.?u,'( /si —c. 1A-1 (tt be 4.Iaoc.�4 thy' n e it_-
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PROPOSED USE:
❑ Multi- Family Dwelling No. Units No. Bedrooms/Unit
CI Business Sq. Ft Retail Space Type 11 l \ni t5 # E y Hours of Ope ation:
�` SDaycare *Preschoolers 4 &• # Afterschoolers `tea 7 • —# Employee: ! • urs of Operation 17CA An '" � p e1
❑ Industry Sq. Fn. Type #Em. • .... N� � Operat l p , :
GI Ch Church Seating Capacity #Bathrooms Kitchen r r W A / l�S"a -
Accessory/Addition /Other (Size II j O x - Use j' Cr cry. (.L-x \7c t'�
Water Supply: (� () County Well (No. dwellings ) MUST have operable water before final ll.V//��. i
Sewage Supply: (__) New Septic Tank (Complete New Tank Check#at (Existing Septic Tank ( ) County Sewer \ - `�\
Comments: C Lk, . \ tlh s 3 `t 4 4
. memaVislit___OlrekTa i a l kiliallals Ia.
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# of Jr nr6 3 'tea r (G - 'SC-E tira\t l (srQ
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_.. . � a sa museitiainres • •
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If permi • egr ante d I agre-� : ' m to . il '' % of the Sta a of North Carolina r regulating such work a t he
f eg g specifications of plans submitted.
I h y alite that foregoing statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
li '- /2— l —D 7
a neturs of Owner or Owner's Agent Date
"This application expires 8 months from the Initial date if no permits have been Issued"
A RECORDED SURVEY MAP, RECORDED DEED (OR OFFER TO PURCHASE) AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPUCAT1ON
Please use Blue or Black Ink ONLY
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