ETApplication
HARNETT COUNTY CENTRAL, PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www,hamett.org/perTnits
APPLICATION. FOR EXISTING SEPTIC SYSTEM INSPECTION FOR
FINANCING _ Wan
NOTE. A DRED OR OFFER TO PURCHASE I R Q I F _~'IMF. OF APPLICATION,
Date: tD ''l f
Proposed Buyer:
Applicantlltoff-mop a;
Mailing Address: L
City: State: Zip:
7 S
Telephone: S Fax • (,f7 ~2~~- 0350
Current Land Owner: Phone:
Property Address:
PIN: Parcel•
Name of Subdivision: Lot # (if Applicable)
Directions,: (please give concise, complete direction$,from Lillington, NC to the property)
a'7 4-n 1 I r C- -li ) r 1 V, 1 .1 1J.
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: It 1 -1-
FOR OFFICE USE ONLY -I
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
L
Z~1;1/ -0
of Environmental Health Specialist Date