ETApplication # OQ 5 00
216 cI
SCANNED
O Harnett County Central Permitting Cad F,eM'
OATS PO Box 65 Lillington, NC 27546 aqq o(0 Q)
910-893-7525 Fax 910-893-2793
www.hamett.org/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: COREY FACIANE Date:
Address: POST OFFICE BOX 92 BROJWWAY NC 27505
Telephone: 919-895-0972
Property Owner: DAM FAcrms Dm PINE FOREST MOBILE HOME PARx phone: H:910-893-5003 C:919-895-0972
Lot Address: LOT #7 52 PRIVIT LANE LILLINGTON NC 27546
Name of Park: PINE FOREST MOBILE HOME PARK Lot Number: 7
Parcel: 1oos5s oo16 is PIN: 0558-62-1970.000
--L-SW DW TW (Size 14 x 66 ) # Bedrooms 2 Year i99s
Power Company: owm R:n a.s me gawp CCVJ4X 1Cy (FOr Progress Energy we need the premise number.)
Specific Directions to Job from Lillinaton:
TAKE S MAIN ST (US 401 SOUTH) APRX 3 MILES, TURN RIGHT ONTO JOEL JOHNSON RD APRX 1 MILE,
TURN LEFT ONTO SANDVIEN LANE, TAKE SECOND RIGHT ONTO PRIVET LANE, LOT IS THIRD (3rd) ON THE
aiuaw.
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 N 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
Authorization of Existing System
Signature of Environmentaa0,4,eaith Specialist
SEPTIC
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Date
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