ETApplication # I / ~ 4 rJ r'~~ C. l L,;'
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(410) 893-7925 FAX: (910) 893-2743 www.hamett.org/pennits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
NOTE. A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: J- g- 12-)
Proposed Buyer or Business ITC:
Applicant/Mortgage ic' 'Ze
Mailing Address;
City: -2>L" t~
Telephone: 01110 _ ff>:31
State:
t Other ( )
Current Land Owne : --)1y) e` A ~
t Property Address: a'} t sae 9", 7
^1PIN: Parcel;
k,) State Road State Road Narge`
Name of Subdivision: Tt`Q,. !
#
Di~Kti ns: (please give con se, complete directions from Lillington, N to the pr perty~
G I .G 5s t7 t tE St CC rJ - C 1- C G~trE l k~ 1 2 1
s t ` I en irt1C 'rte se's asst
l m tz. e n' t to
The a 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 infonnctZi r i ,orreet. J
Signature of Owner, Authorized Agent or Appl' ant: FOR OFFIC . SE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
.____(IPApplicahlc)
7--t-t0
nic
f zip:
Phone: yl-~ - ~