ETApplication
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910- 893 -7525 Fax 910 -893 -2793
www.harnett.org/permits
Property Owner: ��-U'i�1 C Phone:
Lot Address: /1 "1 o / t) AVL4 /; /l .t/'
Lot Number:
W TW (Size # Bedrooms - Year --f 2
Power Company: = (For Progress Energy we need the premise number)
Specific Directions to Jab from Lillington: z 4 b (3 ` T7
There Is a $100.00 charge for this service. This certification Is subject revocation
Intended use of the septic system changes, or If false Information Is provided on this
application.
You signature below certifies that all above infor ation is correct.,
Signature of owner or authorized agent:
SEPTIC 4108
S