ETApplic Lion #
HARNETT COUNTY CENTRAL PERMITTING r
PO BOX 65 LILLINGTON NC 27546
(910) 893 7525 FAX (910) 893-2793 www harnett org/permits
WOMMSEM FIRE DAMAGE, ETC
NOTE A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION 6 Z 13 t/
Date it- 12° / ~ -O
AppIicantfA6e#g*geANP
Mailing Address 1791
City L i
Telephone ( ) (4 D 91
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Current Land Owner +A-r N ►°c6% 4, '-k' Phone I U 0 70 - 2- 7 f.0
Directions (please give concise, complete directions from Lilleinlgton, NC to the property)
Th a is a $100 00 charge for this service T6-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
SEPTIC
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