ET19- r C< Application # t (,3 bag
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793 ( S
www.harnett.org/permits C~~ S -Q C
Application for Existing Septic System Inspection in a o J ell-a neSWr ' L r~ of
Applicant Name: h 7l Date: Z01d
Address: V dl
Telephone: / - 3~9E1 - Rio 3`
Property Owner: 11.4 LQ1, Phone: 9 Id
Lot Address: "T
Name of Park: '~/ay G r/az Lot Number:
Parcel. N06, Oa PIN: _buu, , r c - S(p~'~'U oo
i_--SW DW TW (Size _/Vx_-_W # Bedrooms 3 Year Z v d 3
Power Company: (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
Il? I.e~r\ti'- V F
There is a $100.00 charge for this service. This certification is subject to revocation if the
Intended use of the septic system changes, or if false information is provided on this
application.
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2/08