ETApplication # U�)C
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/permits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
FOR MORTGAGE COMPANIES, COMMERCIAL CHANGE OF
OWNERSHIP FIRE DAMAGE ETC.
NOTE: A DEED OR OFFERJJ /TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date:
Proposed Buyer or Business Name:
. Rf-�L4
Applicant/Mortgage Co:
MailingAddress:
City: Y" State: /lam _ Zip: � C7—�--
Telephone: _ Other #: ( )
Current Land Owner:
PIN: G Lt) / In C/' i7 Parcel:
State Road #: State Road N e
Name of Subdivision:
# (If Applicable)
D care: oyees f children
Re ant: # of emp # o Hours:
Directions: (please give
Y tt—
M
from Lillington, NC to the property)
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 reformation is correct.
VSignature of Owner, Authorized Agent or
Signature of
SEPTIC
FOR OFFICE USE ONLY
TION FOR USE OF EXISTING SEPTIC SYSTEM
Health Specialist Date