ET311 D9
Application # N 5 co a 1 LO _U 7
HARNETT COUNTY CENTRAL PERMTIT NG
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/permits
APPLICATION FOR EMTING SEPTIC SYSTEM IN PECTION
FOR MORTGAGE COMPANIES COMMERCIAL CHANGE OF
OWNERSHIP. FIRE DAMAGE ETC
(~~~NOTE. A DEED O IO~FFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: •r C76
Proposed Buyer or Business Name:
Applicant/Mortgage Co: _ t! er o R- CIA
Mailing Address: d
City: State: N c. Zap: 0
Telephone: (0)4 m.-
3 Other (g») '1'1 S. - C't
Current Land Owner. c., 4-%.e Lo c Yw7 l.Phone 3°1 S 21~v3
Property Address:
State Road #:_c-)
Name of Subdivision:
0
Applic")
# f e lyees`' # of
# of 7mop, os_ #
There is a $100.00 charge for this service This approval is subject to revemtion N 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 USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
/Z&
of Environmental Health Specialist
SEPTIC
3-1Z .07
Date
'5 "W10y37~~') 4ro9
Directions: (please give concise. complete dinecrinna fmm i :n:....~....