ET4 Application # `
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.org/permits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
FOR MORTGAGE COMPANIES, COMMERCIAL CHANGE OF
OWNERSHIP. FIRE DAMAGE, ETC.
NOTE: A/D~E-EfD OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: Pro osed Buyer or Business Name:
Appli ant/Mortgage Co:
Mailing Address:
City: _
Telephone:
State:
Other ( )
Current Land. Owner: -3 A/%AA " t,V N
Property Address: ~'~2 t5
PIN: 0► Parcel:
State Road State Road Nam(
Name of Subdivision:
# of empl
it: # of err
Zip:
# (if Applicable)
Hour-s'--
Directions: (please give concise, complete directions from Lillington, NC to the property)
b G-o ( C.h) PS-C. L- rte? 0, :5 P I-fAt 6 c-&L t... r. ij L1,L.a
-r, 2, Lt V) it-- kK 2 su k 1-,6 Ak B t,r E A61 A,1_e a AA-K-1< 7 rt~.vt
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 correct.
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE E- Y
A HOR TION FOR USE OF EXISTING SEPTIC SYSTEM
`7 N-1)1-1
Signature of Environm tal ea i Specialist Dd e
SEPTIC 4/08
of children
# of seats