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ETApplication # 0 c~ S 0 0 ~2, p Harnett County Central Permitting © Cl c i PO Box 65 Liliington, 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: ~ ow-- t-1nfTac Date41Y40A Address: S ~Al Telephone: Property Owner: a~ c Phone: 919 701 - 57S Lot Address: (,L n _ Mo- Nameol'Park: ~1~ 14 c ~lD Lot Number: Cri Parcel: PIN: -XSW DIN TW (Size -~-x ~ # Bedrooms Power Company: Year- 1 (For Progress Energy we need the premise number.) Specific Directions to Job from Lillin4ton: You signature below certifies that all above Signature of owner or authorized agent. DO NOT SIGN BELOW - FOR OFFICE USE ONLY horization of Existing System Qz 5 ~ ~ Signature of Environmental pecialist Date SEPTIC /o ff S 4/08 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.