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ETApplication # ©`Z 5 O O Z2D Harnett County Central Permitting 0gc1 513 PO Box 65 Lillington, NC 27546 910-893-7525 Fax 910-893-2793 www. harnett. org/permits Application for Existing Septic Tank In a Mobile Home Park Applicant Name: + -PAOw- IFS r r~ Date: 1 3* Address:-1129- S "'..C"l "xuh < - k- - I n Telephone: Property Owner: Phone:, Lot Address: g .1.,, n Name of Park: M ur ~ lf7 M Parcel: - Lot Number: _T___ _ PIN: SW DW TW (Size # Bedrooms Power Com an Year- p y-~ c n (For Progress Energy we need the premise number, _S~~ific Directions to Job from Lillinaton: ) There is a $100,00 charge for this service. This certification is subject to revocation the Intended use of the septic system changes, or if false information is provided on this application. this You signature below certifies that all above i signature of owner or authorized agent v NO SIGN BELOW - FOR OFFICE USE ONLY ation of Existing System Signature of Environmental Healt ial list S l~ Date SEPTIC 1/ ings 4/08