ETApplication
id~n° # 89 500 2iaq et
1 l 05 Harnett County Central Permitting
DATE PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits Ccrh!) (-(e 5y3
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: Date: Z C -
Address: 2 Z y, ` l~ K,,.f G o ,Z 2
Telephone:
Property Owner: lie- 1 .4 ~i O 7V& Phone:
Lot Address: 3 0 r . ecz ~S y
Name of Park: e o u w6 X
Parcel: PIN:
SSW DW TW (Size _x rl/) # Bedrooms --I- Year_Z,~~"
Power Company: Cf JT1L L, 6LEC.7yW-tC- (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillinaton:
/V 6 V- 7a
G-yt,c_ G'yl / c gi A) d a//l l'L.eU-y !~7'
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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 nI is correct.
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
Signatu a of Environmental Health Specialist Date
SEPTIC
ib-b/0 9
4/08
5