ETHARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/pennits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
NOTE. A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date:
e
Mailing Add ess: S aaia~
City: State: Z P C-11-1.---
Telephone: Other#: R~ lq-IqID
Current Land Owner: C' • Phone T
Property Address:
~1 O Parcel: /
77
PIN:
State Road State Road Name:-
Name of Subdivision: Lot # -(If Applicable)
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There is a $100.00 charge r 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
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
2
of Environmental Health Specialist Date
SEPTIC
4/08
Directions: (please give concise, complete directions ~rom~LVlington~NC to the property)