ETApplication
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.org/permits
NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION
Date:.. L -
Telephone:
Fax:( )
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PIN: Parcel:
Name of Subdivision: Lot # _(If Applicable)
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ive concise, complete directions
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'rhere 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 or9ga p
FOR OFFICE USE ONLY
AUTHORIZATION OR USE OF EXISTING SEPTIC SYSTEM
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Signature a (Environmental Health Specialist Date
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SEPTIC O / 4108
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