ETApplication # IZ PP 22Y° 2
Harnett County Central Permitting
PO Box 65 Liliington, 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: Alen Date: ;5-II)/a.
Address: f) . /&Q UZLJ 1t~L Bf
Telephone:/(3I - Ofl
Property Owner: ~,I?r gy!= f40e!, Lc'.C3. Phone:
Lot Address:
Name of Park: Lot Number:
Parcel: PIN: V / L32 otv
✓SW DW TW (Size /y 49 ) # Bedrooms _ 3 Year 0Q0
Power Company: oar es Kitl D lf3Gl~Gr (For Progress Energy we need the premise number.) r
Specific Directions to Job from Lillinaton:
LJ of I 5aA~1 -0-5 r 9 rn , ),e,, i ia,n t . ah t AJ C.5`5 g L~ i
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 informatia i correc .
Signature of owner or authorized agent:
SEPTIC 4108