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ET~ t &7 U/ A& e-~ Im Ofd Application # 11 t; f 0 a ~ HARNETT COUNTY CENTRAL PERMITTING PO BOX 65 LILLINGTON NC 27545 (910) 593-7525 FAX: (910) 893-2793 www.hamett.org/permits APPLICATION FOR EXISTING SEPTIC SYSTEM INSPECTION FOR ETC. NOTE: A DEED OR OFFER TO PURCHASE IS REQUIRED AT TIME OF APPLICATION. Date: !I - x! f t PIN: 21, Z Y -1-7-77aae, Parcel: -_-13 ©S 1 y 00957 State Road State Road Name: Name of Subdivision: Lot # _(If Applicable) Wiggle m ^ mill I Jim Directions: (please iue concise, omplet directions from Lillington, NC to the pro erty) here !-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 informatioon1' is correct. Signature of Owner, Authorized Agent or Applicant .c,--- & FOR OFFICE USE ONLY TION FOR USE OF EXISTING SEPTIC SYSTEM Signature of Environmen lth Specialist D to NEFFIC: 4/08 Applican Maitin Address: U V .9CitY f State: Zip: Telephone: Other r