ETC;
Application I-)
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
FlJR MORTGAGE COMPANIES , COMMERCIAL CHANGE OF
QWNERSHIP, FIRE DAMAGE. ETC.
NOTE, A DEED oR apm TO PuRcmm IS REQUIRED AT TIME 0- FAPPLICATION.
Date: — 4.26,14
Prop(
Appll'
Maili
City:
Telep
Current Land Owner:
Pront-rtv AAAeo...
PlN:_W_ZzL_ 4F--,. Parcel:
State Road State Road Name- J�
Name of Subdivision: Uf Lot
Applicable)
u'recElons: (please give concise, complete directions from Lillington, NC to the '
property)
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 inf ornialion is correct, -D/
Signature of Owner, Authorized Agent or Applicant
FOR OFFICE USE ONLY
TION FOR USE OF EXISTING SEPTIC SYSTEM
I
Signature of Environmental ea h Specialist --bate
rl
SEPTIC Rectcc 4/08 Rp/i/v-