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Application # D'gSd I ( a U(
3
HARNEW COUNTY CENTRAL PERMITTING
PO BOX 651 n I NGTON NC 27546
(910) 893.7525 FAX: (910) 893.2793 www.harnett.org/permits
A-PTLJCATION F TIN YS S N
FOR MORTGAGE COMPANIES rpMMERCIAL CHANGF
OWNERSHIP. FIRE DAMAGE. ETC
NOTE: A DEED Of OFFER TO PURCHASE IS REQUIRED AT 77 ME OF APPLICATION.
Date: 1 C7d
Proposed Buyer or Business Name:
Applicant/Mortgage Co: G'
Mailing Address:
City: _ -!7,:-State: tit t~ Zip: 3: to
Telephone: (i
:)*-j t+- ~t,63 Other (4h) -17) S. l- 41 s's
Current Land Owner. em1 f a d Phone:
Property Address: i
PIN: o~~ z - z - elk., sou 1• c,
State Road
Name of Subdivision: Y'*-%e a,
Directions: (please give concise, complete directions from Lillington, NC to the
There is a $100.00 charge for dds service. This approval is subject to revmdon U the
intended use of the septic system changes or if false information is provided on this
application.
Your signature below certifies that all above in
.formation is cornea.
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
Signature of Environmental Health Specialist Date
SEPTIC 18 lof 4/08
I