ETApplication #
C! { a_~Q,~
HARNET7 COUNTY CENTRAL PERMnTIKG
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.org/permits
APPLICATION FOR EXISTINC,SEPTIC SYSTEM INSPECTION
FOR MORTGAGE COMPANIES, COMMERCIAL CHANGE OF
OWNERSHIP. FIRE DAMAGE, ETC.
NOTE: A DEED O OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: U~
Proposed Buyer or Business Name:
Applicant/Mortgage Co: i= e: d Z r ca L c.-, c-,-, knn~ r- k. a o,
Mailing Address
City: State: N Zip:
Telephone: (ma) 1- 4- "(fo62 Other (cr») _'I1 S- 1:1
~s
Current Land Owner. l 1 Loc. Y") Phone: _ 39 S -
Property Address: L-F ' r~
PIN: -Z -O??oS _ oUy I:_Q4(5(g(gZL ern I S'_ Z 'z~ to
State Road k .x.15 -R~ Name- \-\rn er.. a-.t- e,
Nana of Subdivision: z-' E t..o_ Yre_ o•s~p~ ,I #"---tU,p hemble)
Dimme* of empl children Ii'~s`:
# of to # f ses~a 1-rnn,~•\
Directions: (please give concise, complete d rw ions from Lillinftton.
Your signature below certifies that all above b ormation is corn
Signature of Owner, Authorized Agent or Applicant: /~4
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
III I-If ~ I 9 2'Z
Signature ' vironmental Health Specialist Date
SEPTIC sil g k 4/08
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.