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Application #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793 C
www.harnett.org/permits
Applicant Name:
Address: I
Application for Existing Septic Tank In a Mobile Home Park
Telephone:
Property Owner: r' c Ar _L}% Phone:_~1/0J 11? -
Lot Address: / Z1_ _ ) _ I. _ 17 _rl
Name of Park: I>n CS foe i'to - ' Lot Number:
Parcel: PIN:
SW DW TW (Size _x--U) # Bedrooms Year a
Power Company: (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
You signature below certifies that all above information is correct.
Signature of owner or authorized agent:
DG.NOT SIGN BELOW - FOR OFFICE USE ONLY
thorization of Existing System
Signature of Environmental He . Specialist ate
SEPTIC
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4/08
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.