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Application #JZ ~-fP 2
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.orgtpermits
NOTE. A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPUCATIpN
Date: IL
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 information is rr t.
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXLSTING SEPTIC SYSTEM
of Environmental Health Specialist
Date