SEPTIC Application # 1 ✓ 5799 Z5 5 4/9
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 "•- , •'til Y, I ,d v r "i'i , 1 • , , it. � ,'', 11�0'f ' 4 �t 1 \ dl:MY-.;; Q
,'' .'U , , ;.iir'. FIRE DAMAGE, In
NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: 0` — l — /0
'rope - - • 1 siness Name:
Applicant/Mortgage Co:
Mailing Address:
City: State: Zip:
T- -,•: -. ) Other #:( ) /51
n ' 9 46
Current Land Owner: i_ -ILQl & aaOiC� -61,ltd Phone: 9)O_ S 3 -Q95
Property Address: l?�?�- Unnto) 4' FYc&i in - l lrvt/ 1 LA a.Q321,
PIN: /. — Z- , °! 02I Parcel: L P/ /a
State Road #: /7 7 / q ., State Road Name: , , _
I7
Name of Subdivision: Y 41/21 Lot # (u Applicable)
1+
. nar J�.�-AI�S 4 /
are.: e .. ch dr`e' ■�. �� Hi.. All
i-.1! �t' IN #' ye Mir M'l Sr ♦.o i we—` ♦
D'-ctions: (please the concise, complete directions from Lillington, NC to the property)
5S 1 , -In S�-np 5i J i tury\ 1 net_
13 a Div IZir
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: 112,,A-€ eAtiiR
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
Signature of Environmental Health Specialist Date
SEPTIC 4/08
4 , / i 2_ 991