ET~ Application # 21131
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/permits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
FOR MORTGAGE COMPANIES COMMERCIAL CHANGE OF
OWNERSHIP FIRE DAMAGE ETC.
Proposed Buyer or I
Applicant/Mortgage
bl
State Road #:.JVG /-Y
Name of Subdivision:
# (Tf Applicable)
Restaurant: # of employees # of seats Hours: fr&NN Yet' tr t
~ Svn a
Directions- (please give concise, complete directions from Li tn1'--V-q gton, NC to he property)
. ' "t Ilt~ c k 1 IJ Kz _ C)1 ~c ' l to the
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 in bnmation is correct.
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
d FOR USE OF EXISTING SEPTIC SYSTEM
Signature of Environmental
Date
SEPTIC
D
s
4,08
NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
-X,
Date:'