ETP,
Application #__1 ~ 2 -47 7 ?Z
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/permits
NOWNI ETC.
NOTE. A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: j Z - f4- -Pit' V, aza gwup-)
Applicant 4014-1488 W-
Mailing Address: _
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City:
Telephone: (tJ'
Current Land Owner:
Propert Address: `1
PIN:
State Road G 21 5
Name of Subdivision:
a ' re: f em ye
t t' em y
Directions: (please give co.
°Siate: Jl/G Zip:
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46 arcel: -,5V
State Road Name: R
complete directions
t7 114 K kk r I IS
-Lot #_-Ly
_ VU Lillington, NC to the
f Applicable)
ropert
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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
l- ZG X-13 cl
ignature of vironmental Health Specialist Date
SEPTIC
4/08