ETApplication #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harneft.org/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: _ t t , yy- -Date: t'A:X -Z'D I -Z---,
Address: E~In~ ~._.u Z-C ,stJ A)4I
Telephone:
Property Owner: N t
VIA 'T
(_a'" _Phone: 9 t o 7f> t 66
Lot Address: L~ G,t lrt n t.e.A_ A, r
Name of Park: i Lot Number: Parcel: PIN:
~SW TW (Size x;~) # Bedrooms _ Year q2 Power Company: (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
LL- o 1 «-s0~i~ 13 4 Al L 1 ~ 1 tom W c~-t AJL f.~ ~ [
You signature below certifies that all above information ' corr.~t.
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
w zo S 1 )
Signature of Environmenta Hj, ' th Specialist D to
SEPTIC 4/08
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There is a $100.0 charge for this service. This certification is subject to revocation if the
intended use of the septic system changes, or if false information is provided on this
application.