ETApplication It f 3670 2 E= Z
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/permits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
FOR
IM 11 1 1111' IRE DAMAGE, ETC.
NOTE. A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: [ Z - 7" L~
Current Land Owner: 'dh a L:fifl.~
Property Ad ss: `
PIN:- I ELY4 1 Oa/ Parcel:
State Road ll State Road Namt
Name of Subdivision:
MMdla!!C # Me4lfpleb'' V"3€blsea
Directions: (please give concise, complete direc
Applicable)
from 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
SEPTIC
4/08