ET(.0 / + r ` D Application _ 11~56c) Gr 01?3
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/pennits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
FOR MORTGAGE COMPANIES COMMERCIAL CHANGE OF
OWNERSHIP FIRE DAMAGE ETC.
NOTE. A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: _&4_~ d
Proposed Buyer or Business Name: l(/ Lveggl 6&r- 61WAf
Applicant/Mortgage Co:
Mailing Address: Q "
City:. It/ State: Zip:
Telephone: Other F/0 -0
Current Land Owner: 70 NAJ q, P7V l el a . 41A f _ _ _
PIN: - !s Env Parcel:
State Road a' State Road Name:
Name of Subdivision: --Lot # (If Applicable)
D c # of em oye o children Hours:
R~e : # o employe # seats Hou ,J
Directions: (please e concise, comple te, directions from Li mgton, NC to the property)
'op Ir 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 cor a t.
Signature of Owner, Authorized Agent or Applicant: ~_.-~G~
FOR OFFICE USE ONLY V
TION FOR USE OF EXISTING SEPTIC SYSTEM
Signature of Environmental tb Specialist -t-Date
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