ET~r
A plcatio # ;
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 2754£
(410) 893-7525 FAX: (910) 893-2793 www.harnett.org/perniits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
FOR MORTGAGE COMPANIES COMMERCIAL CHANGE OF
OWNERSHIP, FIRE DAMAGE, ETC
,'TOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OFAPPLICATION.
Date: 2.1 '2-0 (1 1
Proposed Buyer or Business Name:
Applicant/Mortgage Co:
Mailing Address:
City:
Telephone; ( )
Current Land Owner:
.
PIN: ( ~1 • L-744
State Road _
Name of Subdivision: J
State: Zip:
Other ( )
jlu Phone:
Parcel:
State Road Nafht
5
0
Lot # I (,f (If Applicable)
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.
Yoursignature below certifies that all above information is correct,
Signature of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
ON FOR USE OF EXISTING SEPTIC SYSTEM
Signature of Environmental Hea Specialist a
St~ N1`1C' 4/08
oo, ~Fl I / -5
Directions: (please give co cise, complete directions from Lillington, NC to the property)