ETApplication # 9 ~O6 Z~ 40
-
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX (910) 893-2793 www harnett org/permits
Mailing Address 3 y117 , It
Ct,
City G.r State
Telephone ( 19 49T 3!SA Other # ( }
Current Land Owner flit
Property Address
PIN 0 - - OP Parcel
State Road # State Road Name
Name of Subdivision lU y h g p/ h V
Zip
Applicable)
Directions (please ive concise, complete directions from Lillington NC to the propert~iadfvq*d
pD M r l11$1~ 4Ak.P 10 1& (4 a1 -~nA-k L.tFV d+y 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 correct
Signature of Owner, Authorized Agent or Applicant
FOR OFFICE USE ONLY
TION FOR USE OF EXISTING SEPTIC SYSTEM
Signature of Environmental',itealth Specialist Date
SEPTIC
4/08
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14
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