ETApplication #
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HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION FOR
MORTGAGE CO. FINANCING COMMERCIAL CHANGE OF OWNERSHIP
FIRE DAMAGE ETC.
NOTE: _A DEED OR OFFER TO PURCHASE IS REOUIRED AT TIME OF APPLICATION
Date: 4 1~ 0
Proposed flt!ryer V4~ 4- . 19✓1 J/0w'C
Applicant/Mortgage Co:
Mailing ddress:1 1l,GCfk,/LcQ
City: State:
Telephone: Fax:(
)
T l
('urrenl band Owner:
Property Address:
PIN:
Name of Subdivision:
Daycare: # of employees # of children
~55"
KP-4-+ Lt
Zip:
Phone: q 10 6417 -3"
Lot # (If Applicable)
Hours:
Dire ctions: (please give concise, complete directions from L.illington, NC to the property)
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 information is rrect.
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
ure of Envi mental Health Specialist Date
144 Oaver
40
Parcel:
'OVA" 7 PLC x'(UW
8/07
~ C7