ETApplication # ( Z 2 PI 24 j
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/permits
Buyer or Busine5,sName:
Other (
Current Land Owner: ~IM59-R GRouP u.C Phone:
Property AJ ddress: ,F&OZ. P,,. .WAIN. AIC ,2 3y
PIN: - 7 d P° Parcel: d Z 14-0-) 03 q
State Road /~f !1 State 20-f e:
Name of Subdivision: / i rm Ae l^ Lot (If Applicable)
a are- of loyee f chi' Hou
a an : geats ours:
Specific Directions to Job from Lillingtan: /~80~1"
LC~c✓ i~ ~Rt✓IN. itl ~"T~TIZkd ~f/cL Cif. XD• Gfl
r
ullk-uvz„ is sun ect 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:
NMI
v,7.
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
of Environmental Health Specialist Date
SEPTIC / ? 4/08 -Jj 7/2- z-