SEPTIC 4 N» ; t4 fit/ —��
Application # /U C 4 ✓ 6 9
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
ETC.
NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION.
Date: / 0 — / Z — 1/
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Applican , , .. , , : t [Ic+. O1 ? #P S-
Mailing Address: '7 70 C t 6 /a J e a
City: a State: V- <- Zip: o f 7 z I
Telephone: ( ) tj' -id t 775 '? Other #: ( )
Current Land Owner: I'Irly . n Vr77t -I&r iv-- Phone: l
Property Address: 5 as JJ ,. re CA,/& -c a Pea 1
PIN: 04 41 - 0 - b 7, 7c" Parcel: J OS 9 / O /i'
State Road #: 2 OP7 State Road Name: riPar r7 Chore- £ a /t"
Name Subdivision: Lot # Or Applicable)
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F.:��ll , , 4.1 :.!l��� sl: ' , e. /� � ours: rte`(
Directions: (.lease •ive concise, complete directions from L'Ilin: ton NC top pr
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There is a $100.00 charge for this service. This approval is subject to revocation if the
intended use of the septic system changes or if false information is provided on this
application.
Your signature below certifies that all above information is co ct. ,9
Signature of Owner, Authorized Agent or Applicant: . t t
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
Signature of Environmental Health Specialist Date
SEPTIC 4/08
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1
DIAGRAM OF TYPIC L SEPT ... _
I.
._al
• TUT LID
0
POSSIBLE POSSIBLE
HOUSE HOUSE
CONNECTION - CONNECTION
--► 4.
7
POSSIBLE
HOUSE
CONNECTION
POSSIBLE LID SHAPES
1 - 1 SQUARE (SHOWN ON DIAGRAM)
RECTANGLE (OLDER TANKS) 0 ROUND
l
FOR REGISTRATION REGISTER OF DEEDS
KgrTli V COUaTV, R NC E
2883JUU 03:12:54 PM
BK :1789 PG:638-643 FEE:826.10
INSTRUMENT # 241% 013262
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' ?! w__:•. ' RALWARRANTYDEED
Excise Tax: S 0.00 •
Parcel Identifier No. County oar the day of , 20_
By: 'a
Mail/Box to: TART, WILLIS & FUS ' . -. .
This instrument was prepared by: Joseph . T®
Brief description for the Index:
/ /\
THIS DEED made this 26th day of June ' , 20 03, • ..... betwe$ PO T1TfB SEARCH
GRANTOR iii 1 GRANTEE
FOY S. MATTHEWS, Widow M • ' G. MATTHEWS, SR.
1 130 Prospect Church Road 30 1 .. Road
Dunn, North Carolina 28334 C ' . . 27521
The designation Grantor and Grae as used herein shall include said pates, I
nte .. -, ^.. .• I ; • :TM , and assigns, and shall include
singular, plural, masculine, feminine or neuter as required by context
WIT NESSETH, thattheGrantor, foravaluableconsidsrationp &dbytheGrantee,•. -.' . . acknowledged, has
and by these presents does grant, bargain, Gel] and convey unto the Grantee in Tee ship'. :. �., portal of land eihrtted
intheCity Grove Township, a v ,NorlhCaroliaaand
more particularly described as follows:
SEE ATTACHED EXHIBIT "A ", INCORPORATED HEREIN BY REFERENCE AND •. �a ' P : OF ' S
INSTRUMENT.
The property hereinabove described wits acquired by Grantor by insmment recorded in Book e. 0
A nap showing the above described property is recorded in Plat Book page - NC Bar Association Form No. L-3 0 1976, Reviaed ® 1977, 2002
Printed by Agreement with the NC Bar Association —1981 SaftPro Carpomtion, 333' E. Six Potts Rd., '