ETApplication # f
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 MORTGAGE COMPANIES, 11 '1 ~ III M lip
NOTE. A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: "
Proposed Buyer or Business Name:
'-tl .S
Applicant/Mortgage 2o:
Mailing A ress: U.
City: State:
Telephone: } ther { )
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Zip:
Current Land Owner:, Sr O
Property dress: 217R 4~4 q Veo
PIN. - Parcel: _
State Road State Roan Name: " M
Name of Subdivision: p w rve rz-•
r, @ ees i ld
s' t: fem
Directions: (please give concise, complete dire~etionsifrom Lil
'hone:g43 -77?-07/ 1
(3t Applicable)
, NC to the
There is a $100.00 charge for this service, This approval is subject to revocation i
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 co
1
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
AUTiP~TlkN FOR USE OF EXISTING SEPTIC SYSTEM
Signature of Environ
Cr: MU-1
alist Date
Arno