ETApplication # 2- '.m) 202/.?)
Application for Existing Septic
Applicant Name:
Address:
Telephone:
Property Owner: , Phone:
Lot Address: \J. SeC-c- i QA- C lu--in . MC
Name of Park: Lot 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 above i f r ati n A c~rmct_
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
Sign ure of Environmental Health Specialist Date
4
SEPTIC 4108
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
Parcel: PIN:
V' SW D TW (Size L x) # Bedrooms Year 2~,
Power Company. (For Progress Energy we need the premise number.)