ETApplication # 1 2 P 2y/2h2-
Harnett County Central Permitting
PO Box 65 Ldlington, NC 27546
910-893-7525 Fax 910-893-2793
www harnett orglpermits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name ~29&Z-
Address
Telephone
N 'V
Property Owner n R a` r fa Phone
Lot Address's
Name of Park i t 1\41C, 6n4- Lot Number
Parcel PIN
SW DW TW {Size J 1 # Bedrooms Yea
Power Company (For Progress Energy we need the premise number)
You signature below certifies that all abo information is correct
E~Yc~~..-_.----
Signature of owner or authorized agent
SIGN BELOW - FOR OFFICE USE ONLY
uthonzation of Existing System
Signature of Environmenta alth Specialist D to
SEPTIC
4/08
There is a $100 00 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