ET(o7 90
1 ^ v\Q-,, Application
HARNETT COUNW MMAL PERMMING
PO SOX 65 LMLI NGTON NC 27546
(9112) 893-7525 PAX: (910) 893-2793 www.hamett.orglpetmits
NOTE.- A DEED 02 OFFER�To PURCHASE IS XSQUIRED AT TX,i B OF APPLICATI®N,
Tate: _ '�: � 15 • - � '(4�'j'-,,
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Pxbposed Buyer or Business Name: ,®� ; _ Q/t•!. ��t"? ,�,;�.'�,.®-� ej,"'l C 1
Applicant/Mortgage Co.. :-1` 4 Xnuo_►'
City:
ch e A Stated Zip:x'75"'2
if 1''i �i,?�?t 4 Other*( .,
Cuxreztt Land Owner; Phbne• Q51 3q
Property Address: '
liq mom 141,
PIN•.. �- � Parcel•
State Rotel #: State Rdad Name;
Name of Subdivision:
Day: # of employees-, # of children Hours:
e : # of employees # of scats , Hours:
i bQ �e fly love" isgo
el^ iY1
Directions: (please' ' e concise, complete directions from W ington, NC to the pro
.�+ 0
There is a $100.00 charge for this service. TWq approval is subleet to revocation if the
(untended u se of the septic system chsgges or if false Informtion is provided on
application.
Your signature below certifies that all above information, is correct.
Signature of Owner, Authorized Agent or Applicant:
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. , %ATION �, • r ,
rIC SYSTEM
SiP. ,,,, NO
Iris