ETApplication /P ~~Z' ~
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/permits
APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION FOR
MORTGAGE CO. FINANCING COMMERCIAL CHANGE OF OWNERSHIP
FIRE DAMAGE ETC.
NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME, OF APPLICATION
Date. f -
Applican
Mailing Address: 6n C.f'aj t. O Y"
City: e r State -A r.4 Telephone: (9~q) 00Fax: { ) _
Current Land Owner:
Property Address:
PIN:-06 WZ - ?4p-
Name of Subdivision:
yo-0 Parcel:
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Directions: (please give concise, complete directions from Lillington, NC to the property)
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There Is a V. 00. charge for this service. This approval is subject to rev ation if the d
Intended use of the septic system changes or if faire 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
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
nature of Environments! Health Specialist
N C- Zip:
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Date
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