ETApplication # 5'~VZ17 2, 3 ?K-
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: Lanu,!.Lk- Pr e P/111-1414.9 -61,C Date: ~3--/-2~o9
Address: Sfr, E. tAJ.'if,`el M5
S-F Ll., err NG ,~7So~ _ _
Telephone: °f lq - to3 - 34--i
Property Owner: Socw&g. Phone:
Lot Address: 337 (',n~p._ C P S ,rv,a t.x✓
Name of Park: P,`~e tc,r~vtl Lot Number: s►-~
Parcel:_ _Q IQ-514210 i PIN: n5r4 - ~i'3 - ~Dy
-)4-SW DW TW (Size 14 _x Gato # Bedrooms -Year ilk
Power Company.-_, 0,, 1V Q~ns~.r e i et,+y,o (For Progress Energy we need the premise number.
Soecific Directions to Job from Lillinaton:
210 DAIA vAu~ nn ~~rWl~i + C_jlek~
~ &,n Qn-34 w q p
bd~ ice[' ....r !ara..,s~+~-+res'tt-e~•-~-..,.,Ana......vncl~u,Yt.a.~c►~,wofr~r
-IV+ cJ ,
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: /
D NOT SIGN BELOW - FOR OFFICE USE ONLY
thorization of Existing System
Signature of Environ en I Specialist ate
s
2/08