ET-2
Application #
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.
NOTE.- A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: 911. 112
Proposed Buyer or Business Name:
Applicant/Mortgage Co:
Mailing Address:
City: 3"OAAr-0 State: . ...... . .... Zi
Telephone: Other #:
PIN: � i� i
State Road #:
Name of Subdivision:
# I I (If Applicable)
�'3
Daycare: # of employees # of children Hours: --T 2-9
Restaurant: # of employees: :0-- # of seats Hours:
Directions.: (please give conci%jp, complete
NC
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 itzlbrniation iS i,orrect.
Signa(ure of Owner, Authorized Agent or Applicant: 1"4
SEPTIC 4/08