ETApplication # I Q f; eO a
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.org/permits
NOTE. A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: /?~//o
Proposed Buyer or Business Name:
Applicant/Mortgage Co:
Mailing Address:
City:
Telephone: ( )
Current Land Owner:
Property Address: _
PIN: bolt d3
State Road g )
Name of Subdivision:
State:
Other k ( )
V 00 Parcel:
State Road Name:
M_ _1
Zip:
Lot # 1 '-'1 (If Applicable)
Daylcare: #o em 1oyees_ \ # of~h' ren shIour
Res{aurant: # o employees- of seats Hours:
Directions: (please give concise, complete directions from Lilliinrgton, NC to the property)
21d 'o . Lead, /7C~,•}f w C 'r „/a-,r16 .~'l~~W /i►, 14e sG~ou' - 4-2
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 Applicant:
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
n ure of Environm 0alth Specialist Date
SEPTIC
4/08
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
ee-'nr'L"Z 4 Phone: