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Application # ',2 Z6
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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
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NOTE A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIMEd OF APPLICATION
Date UJ
Applicant/ -plampoplifti
Mailing Address _l
City
Telephone
Current Land Owner
State
Other # (
dil? IV 1 154
i 9r,119)
Zip d ,
Property Addr ss
PIN :7!7- L OBG Parcel ,'2L,-,Ay DG 4 -f
State Road # State Road Name
Lot # (If Applicable)
Directions (please give concise, complete directions from Lillington, NC to the property)
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 a ~2L' L",/
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
e
of Environmental Health Specialist Date
SEPTIC
4/08
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