ETApplication IP - P 2 7T7
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 1191111 of
111;J111 1111111=1i 1W ETC.
NOTE. A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: /Z - rI - f0
App]
Mail
City:
Telel
Current Land Owner: Yhone:
Property Address: '
PIN: Z - 2S, Parcel: J ` of
State Road State Road Name
Name of Subdivision: Lot # _(If Applicable)
Of
of
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
Signature of Owner, Authorized Agent or
A
Signature
SEPTIC
FOR OFFICE USE
i FOR USE OF EXl
Specialist
iG SEPTIC SYSTEM
y
ate
4108
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