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Application # Ia 2 3 '2/
G~hf url~ 2 f C11arlP,~ B iTT COUNTY CENTRAL PERMITTING
+~a,•~ ~PO BOX 65 LILLINGTON NC 27546
l Doo 7 us bidy WISE- ~ 525 FAX: (910) 893-2793 www.harnett.org/permits
Cii4n NC Z~SZ o
FOR EXISTING SEPTIC SYSTEM INSPECTION
Premiwq :k++ggq !43 GE COMPANIES COMMERCIAL CHANGE OF
F ors 513-13q-1327 'ERSHIP. FIRE DAMAGE, ,ETC.
NOTE. A DEED UK Ur'FER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: Ol 0 U`'1`t"`~t`~-t~.-~h..~..A-'
.7 9111_~
Proposed Buyer or Business Name: LeomrA_ J
Applicant/Mortgage Co:
Mailing Address: 100 kind xW _1A
City: State: C_ Zip: _ 211513
Telephone: +n .310e Other ( )
Current Land Owner: Phone:
Property _ss: 5 :CY e C
PIN: 0 ydo Parcel:
State Road State Road Name:
~~rl~ / 7l T
Name of Subdivision: #T lam-(
If Applicable)
There is a $100.00 charge for this service. This approval is subject to revocation
intended use of the septic system changes or if false information is provided on tl
application.
Your signature below certifies that all above information ' correct.
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
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~Directions: (please give concise, complete directions from Lillington. NC to the nronerty)