ETApplication #09500a oI UU `t
HARNETT COUN'T`Y CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hameu.org/permits
NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OFAPPLICATION.
Date: :F( - - a 1
Proposed Buyer or Business Name:
,r~„ / f?Gf~os~ey
Applicant/Mortgage Co:
Mailing Address: /hc~/2~✓ G~4~v£
City: - io,a.ra 'Ay State: Ne- Zip: 9sp S'
Telephone: (9Y9) Z S`~r Other (vi) .Iff ssg5!
Current Land Owner: ~'o/f,✓ /N Ae Phone: 919 97sr41
Property Address: / &-4e to r
PIN: U t - " D arcel: 13 ~ "a1 UOt a
State Road ,1x16, co State Road Name:
Name of Subdivision: Lot # (if Applicable)
f children Hours:
Directions: (please give concise, complete directions from Lillington, NC to the property)
r" o /Yt 4, c- c "'./c. T-.4 r y / N T 3o_--,4w, 7-,2 ~4_ e' S - % u iGr✓
Your signature below certifies that all above information is correct.
Signature of Owner, Authorized Agent or Applicant: vim-
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
12-f- /'a
iVI-igignatu"r-c of Environmental Health Specialist Date
SEPTIC '6// 4 /C) 9j 4/08
(,c d R 11 nID9
There is a $100.00 charge for this service. This approval is suhject to revocation if the
intended use of the septic system changes or if false information is provided on this
application.