ETApplication # / Z 2 8 r ,
Harnett County Central Permitting
PO Box 65 Ldimgton, NC 27546
910-893-7525 Fax 910-893-2793
www hamett orglpermits
Application for Existing Septic Tank In a Mobile Home Park
Applicant Name
Address
Telephone
Property Owner Vat r- P froL Phone glct-%6-3v~
Lot Address
Name of Park
Parcel 1 J V V 9 It v
VSW DW TW (Size
L$Wt-kit Number
PIN
# Bedrooms (5k Year q?q
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 if the
Intended use of the septic system changes, or if false information is provided on this
application
You signature below certifies that all abov n rmation correct
1
Signature of owner or authorized agent
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
uthonzatlon of Existing System
6.0 5
6. 5
Signature of Environmenta h Specialist D to
4108
SEPTIC