ETApplication # I / / ro 2 7 Ow
HARNETT COUNTY CENTRAL PERMITTING
PO BOX 65 LILLINGTON NC 27546
(910) 893-7525 FAX (910) 893-2793 www harnett org/permits
Current Land Owner
PIN M2 -
State Road #
Name of Subdivision
Directions (please give
Parcel
I Name
"J!(If Applicable)
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
FOR OFFICE USE ONLY
AUTHORIZATION FOR USE OF EXISTING SEPTIC SYSTEM
of Environmental Health Specialist Date
SEPTIC I , / / 1 4/08