ETC NNED
DATE _
Application # Oct !5W 9'Za' g
044 (I: y 9
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/permits
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APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
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NOTE. A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date:
PWAkCA-tXr
Applicant/Mortgage Co:
Mailing Address:
City:
Telephone: ( )
Current Land Owner:
Property Address: _
PIN'
State Road
Name of Subdivis on
State: Zip:
Other ( )
State Road Name: Il WyN' A101,
Lot # (if Applicable)
Daycare: # of employees # of children Hours:
Restaurant: # of employees # of seats Hours:
Directions: (please$ive concise, complete directions from Lillington, NC to the property)
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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.
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
S-- tp-09 145/9/01
Date
JV
4/08
Your signature below certifies that all above information is correct.
Signature of Owner, Authorized Agent or Applicant: