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Application # r ✓ '7 EPa J z ! a
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 COMPANIES COMMERCIAL CHANGE OF
OWNERSHIP IRE DAMAGE TC.
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NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
i Buyer or Business Name:
it/Mortgage Co:
Address:
City:
Current Land Owner:
Property Address:
PIN:
State Road #:
State:
Other k ( )
State Road Name:
Directions: (please give concise, complete directions from Lillington, NC to the property)
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is a $10 , 0 %se"Itic ge for this service. Th' • val is subject to r catio if the
ed us of the system change r If false in mation is ovided on t is
Your signature below certifies that all above infimn ation is correct.
Signature of Owner, Authorized Agent or Applicant:
' OFFICE USE ONLY
r
ure of Enviro ental Health Specialist Date
SEPTIC 4/08