ETLj I uq Oct Application # nQQ soo? iq j q(
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.hamen.org/permits
Applicant Name:
Address:
Telephone:
Property Owner:
Lot Address: k
Name of
Phone:))4 - ~3 q pn
Number: 2q- o
Parcel: n 1 (53. (0 J ~p PIN:
,-SW DW TW (Size J.-4-x-'J[j # Bedrooms_ YearAF~q
Power Company:~~J("J~ For Progress Energy we need the premise number.)
You signature below certifies that all above inf ation is correct.
Signature of owner or authorized agent: h'7
NOT SIGN BELOW - FOR OFFICE USE ONLY
tlthorizaf<on of Existing System
Signature of Environmental HeSpecialist Date
SEPTIC
CS
~h~lov
s
4/08
Application for Existing Septic Tank in a Mobile Home Park
mere 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.