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ETz33 Application 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. NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION. Dater PIN: / 0 Y, Parcel: Y V State Road - State Road Name: O 1 ~ U Name of Subdivision: -SON RCA-)4-A-1 'S Lot of # of children Applicable) Directions: (please give concise, complete directions from Lillington, NC to the property) All Lioe5-k- 4-© 8~►e-bccue t°_huC~1~ ~a-?urz~y 2~fc. arc c c 3.rr, 1r o oft it btA tZ C> dK 2 t There is a $ 00.00 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 information is correct. Signature of Owner, Authorized Agent or Applicant: FOR OFFICE USE ONLY AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM -2 Signature of Environmental Health Specialist Date SEPTIC - 1 4/08 Current Land Owner: ° i',crtl V C Phone: s l'n e'k C, ,4~1C7 c~ s /il G