ETApplication #
Harnett County Central Permitting
PO Box 65 Lillington. NC 27546
910-893-7525 Fax 910-893-2793
www.hamett.org/permits
Application for Existing Septic Tank In a Mobile Home Park
Applicant Name: Date:
Address:
Telephone:
Property Owner:
Lot Address: ` I L-> t
Name of Park: D~ Lot Number:
Parcel: PIN: - 01 O~
SW DW TW (Size # Bedrooms -3 Year ~ 1
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 provi on this
application.
You signature below certifies that all abov., or ati n
Signature of owner or authorized agar
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
0160-3 C/. -
nature of Environmental Health Specialist Date
4/08
SEPTIC