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ET/ n Application # ` 2- Z Y .-1 Harnett County Central Permitting PO Box 65 Lilimgton, NC 27546 910-893-7525 Fax 910-893-2793 www harnett org/permits Application for Existing Septic Tank In a Mobile Home Park Applicant Name Date Address Telephone Property Owner oq-as-9 - 57?31 Lot Address J Imo- vVIE&S-K- I, S Name of Park ,1t~ (Vlb of 14umber Parcel 1 © !0 2 PIN SW DW TW (Size a xn # Bedrooms a Year Power Company (For Progress Energy we need the premise number) There Is a $100 00 charge for this service This certification Is subject to revocation It the Intended use of the septic system changes, or If false Information Is provided on this application You signature below certifies that all abo nformation is correct Signature of owner or authorized agent NOT SIGN BELOW''- FOR OFFICE USE ONLY horization of Existing System Signature of Envlron ental Hea t tkecialist D to SEPTIC 4108