ET ( Reconnection of electricity only)110 /-""r
Application #
I-IARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.org/pemiits WAhlNED
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
ETC
NOTE. A DEED 'OR-OFFER TO PURCHASE IS REQUIRED AT TIME OFAPPLI 710N.
Dater
Proposed Buyer or Business Name: Ile . l fns 1
Applicant/Mortgage Co: T-
Mailing Address:
City: Dtt W A/~_'A r ~0 r
State:
Telephone: ( ) Other ( )Current Land Owner:
Property Address:
PIN:
State Road
'`-~Name of Subdivision:
Zip:
Phone:
/Q_ "799-1
Parcel:
State Road Name:
I.Ot # '-~~~(tf AppliC61.C)
Da care: # of employees # of children
Restaurant: # of employees- # of seats
Hours:
Hours:
Directions: (please give oncise, com lete dire tions from,LilliXon, NC to the pro
Ll u C .'lei/? o f.~?C ~1 r/i -7' U
4, 0 0-
c u~
There is a $100.00 charge for this service. This approval is subject to revocation if the AV
intended use of the septic system changes or if false. information is provided on this
application.
Your signature helotiv 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
L L9
ign a of En 'ro a Balkh S ecialiet
P Date
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