ETApplication # y 5-r0 2 ! ~7/
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX (910) 893-2793 www harnett org/perF"~- mits
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FOR MORTGAGE COMPANIES, COMMERCIAL CHANGE OF
OWNERSHIP, FIRE DAMAGE, ETC
NOTE A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION
Date /1-29-
Proposed Buyer or Business Name
Applicant/Mortgage Co
Mailing Address
City
Telephone { )
Current Land Owner 1
Property Add ss 1
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State Road #
Name of Subdivision
a care employees-
est ant # K5010-e-1
Directions (please give c
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State Zip
Other # ( ) 1 t
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11- S'-
? A Phone 5
,
, OOJf Parcel 4
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complete directions from
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Applicable)
, NC to the
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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
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Litt
Your signature below certifies that all above information is orrect
Signature of Owner, Authorized Agent or Appl>cant ill ~l -s~
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
of Environmental Health Specialist Date
SEPTIC 4/08