ETApplication # DZ ~_PP 29 ly_
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harneft.org/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: C li f f s-c~rJ~r c Date: i/ MA Y 24:5)) Z
Address: 2 2- Jf- /C ,',-h y ~ycr~ l e3 /✓J J 111V V 2S ~ y )
Telephone: ( v~ -3 G~ cl S 71
Property Owner: &4oy n I~JS. 1 NC Phone: o L( ? (-,I LEO
Lot Address: 12'1~ C t M !d 2n ors Da S62-' C, Ltq trC"~ N 29 El G
Name of Park: e[r4422orf Lot Number:
Parcel: 0I - 6 o o g PIN: O S II? - ~ ~j s o t go o
✓SW DW TW (Size 16 x -7 ) # Bedrooms ,-3 Year 001 t
Power Company: SoUlj (Zttlt; (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
210 1 v► lawVb. S. ~r4tce GwAAWo,4 (S aN '1kC-
Ril(11 AA0VT i WI(Lr ~t~~o2c ww 21)
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 infor ation is correct.
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Signature of
Authorization of Existing System
tb-%5
Specialist
D Ate
SEPTIC 4108