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Application # 19 ~ ro Z Z- y ~ ~
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hame".org/permits
NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
roposed Buyer or Business
Applicant/Mortgage Co:
Mailing Ad s: " .
City:
Telephone:
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:-q 77
State Road I q-S j State Road 4alne:
Name of Subdivision:
7-46 e 0 1 6_ # (If Applicable)
PAC/•1nMn*. ~nFP~=1 Jl _C .'_nl'c
se give concise, complete directions from Lillington, NC to the property)
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
l of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
re of Environmental Health Specialist Date
SEPTIC
09~
4108
Date: oa- 4