ETk,qv. ~e_c Application# 0
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HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.org/permits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION
FOR MORTGAGE COMPANIES, COMMERCIAL CHANGE OF
OWNERSHIP, FIRE DAMAGE. ETC. 04-
NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: 44 /;2 - C;?eo
Prapon 1a)*sr Business Name: L 1~1 fh_ Mao < , /l4S 67f'>>1d04
Applicant/Wrtgage-Ce: J
Mailing A dress: S' 1/1 6 W
Cit `
y: 14 02 ' AT State: Zip: 62 7 SZ
Telephone: Other Oi-b 7 S3 T 3 4bg'
Current Land Owner: L P onet!~ 9 43 ``.V7dp
Property Address: % (o 6 r f
PIN: Orl-I75 - -2110. 000 Parcel: 01{ V0-74 14 L co1,2-
( State Road State Road Name:
Lot # (If Applicable)
Da car : # of employees-'7 _~3_ # of children 30 Hours: ~.~O AM - 5 / 3u ~~7
of cAatc Hnnrc'
-ections: (please give concise, complete directions from Lillington, NC to the property)
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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
UTH ZATION FOR USE OF EXISTING SEPTIC SYSTEM
31 ~d ag
Signature of Environmental Health ialist ate
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SEPTIC 4131,0 ~ IV 4/08