ETApplication a SC~~a g3P?
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.org/perrnits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
FOR
NOTE. A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: ~-9-~/0?
Proposed Buyer or Business Name: CLEU) ®P ✓ QS
Applicant/Mortgage Co:
Mailing Address: ` OO ur
City: A State: Zip: 5 a
Telephone: (44) 4 a- -9 ® 6`~b Other ( ) 2
Current Land Owner:
Property Address:
PIN:
C7')L-o 4.3
State Road
Name of Subdivision:
Directions:
# of children
# of seats-
10
State Road
concise, complete directions from
Anoou N(, a
CSC r l S
Lot #-LI-(If Applicable)
Hours:.
illington, NC to the property)
~~51
There is a $100.00 charge for this service. This approval is subject to revocation if the
intended use of the septic system changes. or if false information is provided 'on this
application.
Your signature below certifies that all above information is
-Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
AUTH4 'ION FOR USE OF EXISTING SEPTIC SYSTEM
t
}
SEPTIC
of Envirogmental Health Specialist
Date
4/08
r
12-