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Application dE;~~(,
~V -L/ HARNETT COUNTY CENTRAL PERMITTING
64, PO BOX 65 LILLINGTON NC 27546
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(910) 893-7525 FAX: (910) 8932793 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 OF APPLICATION.
Applicant/Mortgage Co:
Mailing Address: j 1
/V L Zip: --L2`,z:: ~
Current Land Owner:
Property Address:
PIN: 9E 7= 2 -
State Road Z
Name of Subdivision:
UUv Parcel: _
State Road Name:
Directions: (please give concise, complete
# (If Applicable)
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 information is correct.
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
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i ture of Enviro Health Specialist Date
61 /
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Date: /0 - la