DEMO APP Initial Application Date: V — - Application # 5J 2 ✓ 9 l G,
COUNTY OF HARNETT DEMOLITION APPLICATION
108 E. Front Street, Lillington,,NC2 Phone: (910) 893 -7525 Fax:(910) 893 -2793 www.harnett.org /permits
Land Owner: 1re8111.} VI
n i'ItcL``ae( c 9 a5 Mailing Address: q rv€ i f r c
City: ball ' BLLI / I ct j � Sttate: , LZip:[lS&S Home #: 9Il 25g Contact #: Q (- 11 Q o 9
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APPLICANT *: ,,` OliSk \ t Or r' S �� � J Mailing Address: 47.1;6 Alcoa �' �/�/
Cit (Ali W ton State: NCZip: '7✓ #: Contact #: q I � 4 " a
*Please fill out a#plicant information if different than landowner � (�}
CONTACT NAME APPLYING IN OFFICE: f r ��6Ya i �orn�' Phone #: art // T ' Q - �� 7
PROPERTY LOCATION: Subdivision: �A n/� Acreage: /
State Road #: I Z Z ,Y State Road Name: G NJ ®®
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Parcel: /✓ Q 9t �/ 9/ / 9PIN: / ( M 4 1/ /5 - 6;21 Off' Zoning: in , giood Zone: _
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
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Structure(s) to be demolished & removed: Single family dwelling Manufactured Home Other (specify)
Structures (existing and/or proposed): Single family dwellings Manufactured Homes X other (specify)
Water Supply: - ( S k) County ( ) Existing Well
Sewage Supply: (_4) Existing Septic Tank (_) County Sewer
* If a new structure is to be replaced on this lot, please ensure that existing septic system is not damaged.
* If an existing well is on site and is to be discontinued, please contact Harnett County Environmental Health for assistance.
*Upon the issuance of the Certificate of Compliance, the Harnett County Tax Department shall be notified of the removal to
ensure proper listing.
Th demolition contractor is responsible for submitting verification of proper disposal prior to the Final inspection.
* *PLEASE NOTE* *Failure to completely demolish, remove, and clear the premises will result in the withholding of the Certificate
of Compliance. Thus, future permits for the property will be denied, and fines may be imposed for failure to complete demolition/
removal.
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 tate that foregoin tatements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
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Sign u of Owner or Owner's Agent Date 66
"'This application expires 6 months from the initial date if no permits have been issued`*
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