ET- 3 J- J Application # 1 p S 60 5~
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.org/permits
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 OFAPPLICATION.
Date: k • 3 r1
Proposed Buyer or Business Name: l r
Applicant/Mortgage Co: -7 V1 _U00 Mailing A ress:
City: CI State: Zip:
Telephone: (1jl - Other ( )
Current Land Owner:
Property Address: 4
PIN: 95 "7 o00 Parcel: 3 7
State Road O g State Road Namur
Name of Subdivision:
Phone:
Lot # 1.3 (If ADD I icable)
There is a $100.00 charge for this service. This approval is subject to revocation if the
intended use oft a septic system changes or if false information is provided on this
application.
Your signature below certifies that all above information is
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
Directions: (please give concise, complete directions from Lillington, NC to the property)
1,
0 4,14