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Application # 0 8 5c of G Sa (Q
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.org/permits
FIRE DAMAGE ETC.
Date: -1 /_1S /D 8
Proposed Buyer: hen %K} rro<
Applicant/Mortgage Co:
Mailing Address: (~gne-
Ci Telephone: . _ State: t4c Zip: 2733 2
)pax: (aI1-~? 9 - /ggS
Current Land Owner. ~ 9/9 1199
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Phone:
Property Address: a
PIN: 137- -2 -
~7~,nnn Parce.1bC>1-3 _ COZO -
Name of Subdivision: r V w ~G ~h~4 ?
LOt #17 (tf Applicable)
Da care: # of employees-L/P- # of children i✓-1~~___Hours: 'Vita
(please give concise, complete directions from Lilliegton, NC to
Z~ .4 A ,X- A /P L. a -l _ -T-. ._"r _ '
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There is a $100.00 charge for this service. This approval is subject to revocation if the
applicationintended use of the septic system changes or if false information is provided ti this
.
Your signature below certifies that all above information is correct.
Signature of Owner, Authorized Agent or Applicant: JJdMgI LD
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
Signature o Env€ronmenta ea th Speciallst Date
2/08
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