ETApplication # ~ ~ ~ AR 0Z
Harnett County Central Permitting
PO Box 65 Liliington, 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: ~✓~q w4u-'_/?a~,,lC 1-!rr f Lcc, Date: _J - I a - 61
Address: 5 (Q e W ,~l I r a V\A% t..)G '2-7-5'01
Telephone: Ol in - (e 31- 341
Property Owner: ~a W~-e' Phone:
Lot Address: q $ ~ A o ~ ~ NJ
Name of Park: i n e kr+o l Lot Number:. 4-Z
Parcel:n i n5-t4 D 5-7 -)-n I PIN: Q5"I4 -RM -g~ICo . o~v
)4 SW DW TW (Size ►4- x -7z ) # Bedrooms Year lq
Power Company: S~ t -~nr (For Progress Energy we need the premi a numb
Specific Directions to Job from Lillingt n: ' p
"LID SC)A~
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 agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
uthorization of Existing System
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Signature of Environmental h Specialist ate
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