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Application #I 5 d d ~T So7~
HARNETT COUNTY CENTRAL PERMI'T`TING
PO BOX 65 LU LINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.orgtpermits
APPLICATION FOR EXISTING SEPTIC SYS'T'EM INSPECTION FOR
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FIRE DAMAGE ETC
NOTE: A DEED OR OFFER TO PC~R/'rIASE IS RM171 PFD q y' TIME OF APPLICATION
Date: S 2 7 . /
Saab
Applicant 1 roW o c L./ A~:"-S.v.J
Mailing Address: 14<1C EIS
City:,- 4~ec,N4'Tari State: Ne. Zip; 27SSi6
Telephone: (11 770 / 2 0 : Fax: ( )
Current Land Owner: _ C-64.,,4 w,q'7 Sa Phone: `7/9 '726 -Z62
Property Address: _14c 6 4, S e,F Q r , e e e . 4 ,^e„d e z 7 Tf-
PIN: - - 1 ObD Parcel: f 3 7 tD 5 7
Name of Subdivision: Lot fL (tr
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Directions: (please give concise, com I t directions from Lillington, NC to the property)
W 7 7W16 ~2 ox /S- MI&X9 1-44414 00'r-'S 90 a M.4ES 144" ROGNT Od !1`11GR'o-10
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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 correct.
Signature of Owner, Authorized Agent or Applicant:
FOR OM CE USE ONLY
AUTII1R,RIZAg!!p J~qR USE OF EXISTING SEPTIC SYSTEM
Signature of Environmental Health S alist to
SEPTIC
4/08
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