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o\ Application #
HAIRNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX: (910) 893-2793 www.harnett.org/pennits
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 OFAPPLICATION.
4-J4 Land Owner: bcsdr Al iS,4i+e, wen,~ Phone: -54:0 - $A-5 -36*1 thm sf.
Property Address: 56 Wise (Zoo J.#- Mc- Z%33 Wt
PIN: 15UP-29-2-7!0-000 Parcel: N
State Road i'iq9 State Road Name: wt-s& flva4-Q
Name of Subdivision: -lAmes, VQ&.4r "Msa,s ffr, •e Lot # (If Applicable)
Daycare: # of employees NIA # of children
Restaurant: # of employees 91k # of seats
Hours:
Hours:
Directions: (please gives concise, complete directions from Lillington, NC to the property)
See 0-ftac6j
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
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
6-16
of Environmental Health Specialist Date
SEPTIC 4/08
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