ETApplication # o 5 o o Harnett C
ounty Central Permitting
PO Box 65 Lillington, NC 27546 ANNED
910-893-7525 Fax 910-893-2793 SI I
www.harnett.org/permits DATE
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: ocG~ -PAO taE
Date: 43
Address:
Telephone:
Property Owner: ~ Nh, ► ~
Lot Address: • i ~Phone:~ 19 ~ ~i 04 _ S75
n&I C. Z$
Name of Park: _t~ ~rG~r4 Ssia~c r"
Parcel:. Lot Number:
PIN:
~SW DW TW (Size 1U__x_ # Bedrooms _2_ Year~Gg
Power Company: " ..+RO 1 M n
(For Progress Energy we need the premise number.)
S ecifi Directions to~lob from Lillington:
There is a $100.00 charge for this service. This certification Is subject to revocation
intended use of the septic system changes, or if false Information Is provided on rovided oif the
application. n this
You signature below certifies that all above
Signature of owner or authorized agent
NOT SIGN BELOW
O -FOR OFFICE USE ONLY
Authorization of Existing System
Signature o Environment alth Specialist s
Date
SEPTIC
~lXf
.J
4/08