ETApplication # 0 2
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 System Inspection in a Mobile Home Park
Applicant Name: 5 Date: / - .2. X - og
Address: 4,11 t o, 04 ,r z~ tyG
Telephone: 910
Property Owner: Pon k Pamf s ~ 0,"a Phone: IIV - 48 y- 63,44
Lot Address: ;t 14 -54 is pi r LnN C z.7 ros _
Name of Park: Alas L&- %'n Lot Number: I/ -LA
Parcel: 03!a 59 7 Ooa 3 PIN: 93797- 89 - (6212 , ooo
SSW DW TW (Size I_x_ off) # Bedrooms Year l 4 q ?
Power Company: c~~.~~ c Fr"-Q:C (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
4v:~
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
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
\ An O~-I3-31
Signature of Envir nmental alth Specialist Date
aa/3/oy S
2/08