ET RApplication # 0e)- S O O- 20 Z 3
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HARNETT COUNTY CENTRAL PERMITTING o j
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/pennits
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: q1 a 1 11)
Proposed Buyer: JC
Applicant/Mortgage Co:
Mailing Address:
City:
Telephone:
NC to the
h C..
Current Land Owner: l~~C~t tr. d W~ln~s~.n ZPhone:9/9 ~/9&'-ZZQc,~
Property Address: / IV I c s e DI V
PIN: A 597 - 31 - 74/y.2 , o y o Parcel: _d.39 S S?'7D 2 F7 Da D 99
Name of Subdivision: _ er i eLi EG le 1 Lot k-11-0 (If Applicable)
Daycare: # of employees- # of childrenl~ Hours: /V
: (please give
Zip: X7.33
't'here 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
FOR OFFICE USeONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
Si ature of Environmental Health Specialist Date
I%1
2/08