ETi Y
C l "Application #
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HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546 b
(910) 893-7525 FAX: (910) 893-2793 www.harnett.org/permits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
FOR MORTGAGE COMPANIES, COMMERCIAL CHANGE OF
OWNEERSHIP FIRE DAMAGE ETC.
NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date:
Proposed Buyer or Business Name: _
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Applicant/Mortgage Co:
Mailing Address:
City:
Telephone: ( }
State:
Other ( )
Zip:
Current Land Owner: ~ )'Qe-` ~ c ~
Property Address:[.
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 infognatiun is co
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE bNfl~~
A T ATION FOR USE OF EXISTI TIC SYSTEM
Signature of Environmental Healt ecialist ate
SEPTIC 11 4/08
PIN: t>5",:~ Le - Q 1 ' l -Parcel:
State Road Wa State Road Name: ieja
Name of Subdivision. -°-y_._-".-_ Lot # (If Applicable)