ETApplication #
Harnett County Central Permitting
PO Box 65 Llliington, NC 27546
910-893-7525 Fax 910-893-2793
www harnett org/permlts
Application for Existing Septic Tank In a Mobile Home Park
Applicant Name F i U 1 S F(Xi L Cl LA" Date ) 2- -
Z-Address '5 1 LUI CDCA. -5-,On _a VIYA11,sh- LL ZIS)E
Telephone p ) ( - q Rq - ,~l
Property Owner
Lot Address _
Q (q - (4q - gl Rb
Name of Park }5 M I+' Lot Number 2-
Parcel 0~7y o0` 2- PIN ifflI/ ~ 2 /
-~ZsW DW TW (Size LJ x # Bedrooms Year
Power Company (For Progress Energy we need the premise number)
Saecrflc Directions to Job from Ld6naton
rn
oyl C /ar "L5
112 Pn IL. M Qa is NA P on r
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 above information is correct
Signature of owner or authorized agent %-e' Za.A4
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
Signature I Envlronme ealth Specialist Date
SEPTIC
4/08