ETtN,, eC 121 y /O'F Application # 9 ~-Pr Z f /,p
Harnett County Central Permitting
PO Box 65 Liilington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
Applicant Name:
Address:
Telephone:
Property Own
Lot Address:
Date:
Name of Park: J I XI ~AkS - r I Z EJ42 Lot Number:
7S I: PIN:
W DW TW (Size x # Bedrooms
„~5Year ~ ~q-
Power Company: } (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillinciton:
You signature below certifies that all above info mation is co rect.
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
Signatu 6 of Environmental fth Specialist -----t-'- ate
0 ~ 76s / al3/~eS
SEPTI
cation for Existing Septic Tank In a Mobile Home Park
4/08
K
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.