ETApplication # 11-500-a (01 1
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546 p
(910) 893-7525 FAX: (910) 893-2793 www.hamett.org/permits 2
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 APPI.ICATION.
Date: /a 7 1
Proposed Buyer or Busine s Name: f-al
Lit-
f+ of t tie Z
Applicants lortgage Co: r r C fa `
Mailing Address: D - j~
City. State: _ A)C^ . Zip: CqJ
Telephone: (J Z; -,-'3 _ Other ( }
Current Land Owner: f h, c - ~1
Property Address:
Name of Subdivision: q4t 'l r'r'ttt~ Phone: I
PIN: 9Labl- ` y3~s • ~ Parcel:
State Road State Road Name:
3~'( Cry ~7G~3to c~Z.
L~.
Le4
-Lot # ttt AgFficubtet
Daycare: # of employees_ # of children Hours:
Restaurant: # of employees # of seats Hours:
give concise, complete directions from Lillington, NC to the
- I 1t~'J C~t't IQe lnurl f4! C~ ro
There is a $100.04 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.
Sign ure of Owner, Authorized Agent or Applicant:
FOR OFFICE USE ONLY
TH IZ ION FOR USE OF EXIS'T'ING SEPTIC SYSTEi4'I
N (zM5 C ~ 1
Signature of Environmental h Specialist ate
SEPTIC
4/08
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