ETApplication # /0 4 / 23 ~ 2-
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LELLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.org/pennits
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ME A DEED OR OFFER TO PURCHASE IS REOUI.RE AT TIME OF AP-PM-CATION.
Date: / - 4- ZO/D
VL
Current Land Owner:
PIN: /5 X0 -
Name of Subdivision:
Parcel:
_(If Applicable)
(please give concise, complete directions from Lillington, NC to the
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 informatipn is correct. e ,
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
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ignature of Environmental Health Specialist
SEPTIC
1-8-10
Date
4108
N
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