ETApplication # 0 q SO a Z t- q
3 1 S l Oq 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 INSPI CT10N
FOR MORTGAGE COMPANIES, COMMERCIAL CHANGE OF
OWNERSHIP. FIRE DAMAGE. ETC
NOTE. A DEED O OFFER TO PURCHASE IS REQUIRED AT TIME OF APPUCATION.
Date: CAD
Proposed Buyer or Business Name:
Applicant/Mortgage Co: L cZ0 at V CL
Mailing Address:
City: State: N C.._ Zip: :;►7-) 3 3 0
Telephone: (0)s) X144 L4to63 Otherk (c)m) "17)S-Q1 5s
Current Land Owner: Ec d,. 'Gk LgGr1 Y''14•Phone:_
Property Address: O - (A
PIN: h to V - . • C1{?~_ l'
State Road
Name of Subdivision: o. a ApOWabe)
Dshc # of a oy o Idren Hou
# emplo # of t~
Directions: (please give concise, complete directions from Lillinaton.
Your signature below cerlfies that all above information is correct.
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
AUTHORIZATION FUR USE OF EXISTING SEPTIC SYSTEM
of Environmental Health Specialist
SEPTIC
.3- /Z-OF
Date
811 g(rx/- 3holo9 4/08
3
There is a $100.00 charge for this service. This approval is subject to revocation if the
intended use of the septic system chances or If false information is provided on this
application.