SEPTIC Application # / 5 25 7 2,
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 i'•1B;,l HY.. 1- 1 >.(111: lt� �ii•n y�..1: it i2.
IRE DAMAGE, ETC.
NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: � - 7 -
Applicant y Ira, 1 o ar ..
Mailing Address: 9 39 5 5 S 'RA
City: C4r vvan prl State: NC. Zip: .3-2
2 b
Telephone: (gla Oat S -14 c% 14 Other #: ( )
Current Land Owner: ' okfJ i -efFc Phone:
Property Ads r- ss: - • • r ` ' . • - _
PIN: ' S - • a I ; 07 Parcel: €200
State Road #: /EL State Road Name: i i, 'i:,, i.
Name of Subdivision:_ Lot # — i1f Appscabte)
AIM 0
# p e sea rs:
Directions: (please give concise, complete directions from Lillington, NC to the property)
an uJa-44- t X — ram` OLDS ci„ 1 /�, LP
OypetcS
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.
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Signature of Owner, Authorized Agent or Applies � :/ � �ili�tii
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
Signature of Environmental Health Specialist Date
SEPTIC 4/08
N35193