ET9108932793 t Harnett County Planning HARNETT CO. PLANNING SERVICES 06:16:23 p m. 01-25-2010
Application ; _I . lj j~4 4Z
HARNETT COUNTY CENTRAL PERMITTING
PO Box 65 LILI,INGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.org*rmits
APPLICATION FOR EXISTING SFPTTC STEM INS TION FOR
FIRE DAMAGE ETC
Date:..
NOTE: A DEED OR OFFER TO PURC A 4E IS REQU o AT 77FdE , r~,LICATI N
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Current Land Owner: ~.yn c~~' tL0 v~A
Property Address: !j e, ~2 A Phone:
PIN: ~sl4 - 3 (-j,76 4, 0oc) ` v
Parcel: p
Name of Subdivision: _),b A I Lot # (If Applicable)
Your signature below certifies that all above information is correct.
Signature of Owner, Authorized Agen~or Applicant:
FOR OFFICE USE ONLY
AUTHORIZA'T`ION FOR USE OF EXISTING SEPTIC SYSTEM
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re of E nmental Health Specialht Date
SEPTIC 6
4/08
1 !2
Paamc Lkl~
A739A, R3
There Is a $100.00 charge for this service. This approval is sabJect to revocadon If the
intended erne of the septic systan changes or if take infornwtlon is provided on this
application.