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HARNETT COUNTY CEN AL 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 21- C/
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Marling Address
City C--nrr~
Telephone QI
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State Road # State Road N e '9• 4
Name of SubdivisionL` ivaid Lot #----L-(If Applicable)
give concise, complete directions from Lillmgton, NC to the property)
I I rte C n/'~ i . n &-i- r--k V , t ) 1'c Y
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
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FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
of Environmental Health Specialist
SEPTIC
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Date
4/08
1