ETApplication 5-LW 2~,
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
FOR MORTGAGE COMPANIES, COMMERCIAL CHANGE OF
OWNERSHIP, FIRE DAMAGE, ETC
NOTE A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION °
Date
Applicant/1iAN C r?A
Mailin Address 13y6 Ind, -N 02vf
City ( '0 :5 State vG zip 75.E t
Telephone Ito) ii 7 Y3-57 -Other # (//v) 9833- 016.3
Current Land Owner /A_ C '/)Ax le- o Phone 9/0' ?V 2 - ~SS7
Property AMv 15' , ~6, ~ ! - q6
PIN - 000 Parcel a fl 4
State Road # Z If e r State Road Name
Name of Subdivision - Lot If Applicable)
Directions (please give concise, complete directions from Lillmgton, NC to the property)
L / 70w,4R S D'4^W.rR+i 46r"3~' Ai C vo-, .11iR~o2T
lM' EOIgT L✓ 8~7~ del6/% o117o 3r,r_Jr rt✓/ t'o^~ , 1o 1'
rn,1rs ffp~SP ,,.,1/ ~e c.L" Ac-uss -~oyyi C'o~dJs ~lfr„e~ilr~y ail
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
C 'I
SEPTIC 4/08