ETApplication # ZFE
T
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/perntits
NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: Dl - ~ - 2
rap siness Name:
Applicant/Mortgage Co:
Mailing Address:
City: State: Zip:
T ) Other ( } 9/o C?6
Current Land Owner: rr &d Phone: 9, Q '`9ct 3 - 4
Property Address: C'. Z
PIN: a6_7 6V10 Parcel 2-
State Road 1-7 '7 _ State Rpad Nam : &144 e"i
Name of Subdivision: f ; le,( Lot # (If Applicable)
ve concise, complete directions from Lillington, NC to the property)
-•-M V--~i ~-yl rA IF,1/ a r 4 h t & rY i J-" i I r` c 112 -fry
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: D&c-c~-P
SEPTIC 4148
J11 • rJ/~/ ~J/////~f/{//J+ e l ~ q ~f
f l Cam.-- i " s
4_ C