ETApplication # U ~ -Pp Z ~ 01~p
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/pennits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION FOR
MORTGAGE CO. FINANCING, COMMERCIAL CHANGE OF OWNERSHIP
FIRE DAMAGE ETC.
NOTE, A DEEDOR,OFFER TO PURCHASE IS REQUIRE AT TIME OF APPLICATION
Date: / 2 r-- ff
Proposed Buyer:
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PIN: - O~DParcel• 0~ 1-2041
Name of Subdivision: Lot #--L_(rf Applicable)
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tibns: 4please give concise, complete directions from Lillington, NC to the property)
There is a $100.00 charge for this service. 71is 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 informatioq i.4 corned
O iti- oVOwner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
of Environmental Health Specialist Date .
SEPTIC 112. G/ 10 4108
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