ETApplicant I
Address:
Telephone
Application #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910 - 893- 2793,
www.harnett.org/permits
Application for Existing Septic Tank in a Mobile Home
Property Owner: ,f�v' r, r- rw[►t:
Lot Address:
Name of Park: Number: _
Parcel: i PIN: t� , b "V
SW DW TW (Size xi # Bedrooms Year
Power Company: (For Progress Energy we need the premise number.)
Speci fic Directions to Job from Li[lin ton: �l+
�.. S K.. L
L
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 agen ;
DO NOT SIGN BELOW — FOR OFFICE USE ONLY
Authorization of Existing System
re of Environmental H Ith pecialist Date
SEPTIC
4/08
n'