ETf Application # )
HARNETT COUNTY CENTRAL PERMITTING SCMNED
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.org/pennits nAT1
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
FOR MORTGAGE COMPANIES COMMERCIAL CHANGE OF
i
OWNERSHIP, FIRE DAMAGE ETC '
NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION. "SA-cc ~e
Date;
Proposed Buyer or Business Name:
Applicant/Mortgage Co:
Mailing Address: 10 MMct'Du4ir
s r4t7 ` s
City: _?01 State: A1,_C, Zip: 2_7 33 -
Telephone: (,1Q ~iqq -LiI6_2 Other ( ) 413 (1*61
Current Land Owner: Lr-v, -___Phone: __'4 tq- L_t9 400
Property Address: q D MC~D bA,A.a _ <AA.:''.gin . Jr -7 -7 ° ' 2
PIN: c"
c Parcel: _ i CnW " 3,"
j %a
State Road 0~ t.4 State Road Name:
Name of Subdivision: m_ Lot # L ~ (if Applicable)
a care:of employees 4W children _ ..,M Hours .
R staurdnt: # of empleyee&~ # of seats Hours:
z
(please give concise, complete directions from Lillington, NC to the property)
charge for this service. This approval is subject to revocation if the
There is a $100.00 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 correct.
rSignature of Owner, Authorized Agent or Applicant: Lina-
FOR OFFICE USE ONLY
J FOR USE OF EXISTING SEPTIC SYSTEM
Signature of Environmental
-J!~ ~ V1-
D to
SEPTIC
4/08