ETT~u AI/o P1 3 75 y7
6" ~ 9/6 Y 13 75`2' o~/2PPlication SpOz 33,0
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LE LLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/pemtits I -Jtm. DATE
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION FOR
MORTGAGE CO. FINANCING COMMERCIAL CHANGE OF OWNERSHIP
FIRE DAMAGE ETC.
Date:-// . \ `
Name of Subdivision:
(If Applicable)
° e 1 s:
(please give concise, complete directions from Lillington, NC to the property)
7 th '7....-. A t-1 - _ - n A .
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 informati correct.
Signature of Owner, Authorized Agent or Applicant: 'yy~ceeN 1 1A'1
\
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
OD- /,-V- , ? '
laj-
of Environmental Health Specialist Date
SEPTIC/v
_l 4/08