ET'Arl - 14
Application
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.org/pertnits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION,
City: —
Telephone:
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care: pKefmp%oes, c t"e� Hours:
ur�
.#0 em es
— # of s at
sitaur, # of eta vees #of seats
Directions: (please give concise, cqxuplete directions from Lill ngton, NC to the property)
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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 infonnation is
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
t�7-
14
nature of E nvIlrournental ffelalth tsi�)e�
pecialist Date
SEPTIC 4/08
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