ETApPllcation;
Harnaft County Central Permiling
PO Box 65 Lillington, NC 275(46
910-893.7525 Fax 91 0-8 932 793
www.hamett.org//pe�its
Application for Existing SeptiC Tank In n u..�°._ _
Applicant
Address:
Telwphonf
; Property Owner.
Lot Address:
k
'Name of Park:"
Parcel: 4—A(O -- Lot Number.
—SW ✓yy --�— PIN:
--TW (Size xA # Bedrooms
Power Company: G — �— Year�l
----------- _(For Progress Energy we need the
S ecific Dir ctio sgL, Promise number.)
'thereis a $100.00
intended charge for this seryrice. This certification
the septic s;rstem is subject to revoostlon if the
application. use of tohanges, or If false information ie Provided on this
You signature below certifies that all above information is eorredt.
Signature of owner or authorized agent:
FOR OFFICE USE ONLY
O
Of Existing System
Da
3EPflC
. 4/08