ETI . ri - 12> Application #135X_3_;�
HARNETT COUNTY CENTRAL PERMMING
PO BOX 65 ULLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/permits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
FOR MORTGAGE COMPANLL&JJajA= IAL CHANGE 0
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OWNERSHUff FRE DAMA-Q-gPETc.,
NOTE. A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME Ok,� )ATION.
Date:, 0- 1-1.3
Proposed Buyer or Business Name: 51 1.zt 0-L't � 0 k
Applicant/Mortgage Co:
Mailing Address: f / 2- q
City:
State: N zip: a -7 5c/
Telephone: 1 57 9,C- Other #:( )
Current Land Owner: W,'Ll6k., fitm0y-or4 Phone: �
Property Address: _i).5 9, f "g t, ej" 9, n— Jo
PI,N:CI&Q -1c, t9 0 O� Parcel:
State Road #: State Road Name: iZ1'_V_C/_ le- P1
Name of Subdivision:-, 6,---,c h Alt IA)t Appfickt,)
D4yc,-a_re: of emp ces #_CoTthildgren Hours:
1p
a�Reim v # of emint # of se.
Directions: (please give concise, complete directions from Lillington, NC to the property)
7+� 7 T,111 Aciror- 17 1Y L /7-
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 it false information is provided on this
application.
Your signature below certifies that all above inf6rmation is
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
Signature of Environt'Wendl Health Specialist Date
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e-rICA 10113
4/08