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ETApplication #A ?.~.3 Sto HARNETT COUNTY CENTRAL PERMITTING C 0~'" f ooh vl~t Ill PO BOX 65 LILLINGTON NC 27546 (910) 893-7525 FAX: (910) 893-2793 www.hamett.org/permits APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION FOR MORTGAGE COMPANIES, C. NOTE. A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION. Date: 6 -30 -o T Proposed Buyer or Business Name: c5 he r ",a ti To n Applicant/Mortgage Co: Mailin ddress• ' City: State: Zip: .0147106 Telephone. (914 fl%t 211Q, Other ( ) Current Land Owner: 00C'I'A Phone: 910 -ell/e r / kIA Property Address: S'o. o Pa~ t,4 • ©5_-~g -38- toiq.ooc> State Road State Road Name: • Name of Subdivision: S1'O;F6-,AOW RO 40,1-V& $T Lot # S 3 (If Applicable) Daycare: # of employees Al 14 # of children Hours: Restaurant: # of employees . N # of seats - Hours: Directions: (p=T a give concise mplete directions from Lillington, NCB to the property) o f'1`Tlo - /N~c.eJ T 1.*4 4/9 Ai CK-VAAD RO•M Ze.Tio, i1'a ~S•o G AJ IC. Ckf- 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. Your signature below certifies that all above information is correct Signature of Owner, Authorized Agent or Applicant: ~~KJ4' FOR OFFICE USE ONLY AU I FOR USE OF EXISTING SEPTIC SYSTEM P -1 1"41 bo~ Signature of Environmental Health S ist e SEPTIC ~~r 4/08