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Application # ✓ 4 J
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
for 4[stin%Septic Tank in a Mobile Home Park
Applicant Name:
i~
O
Address: l -7 /0 1.L4a,,.! C~
Telephone: 3_10- S -L - -3,230
Property Owner:
Lot Address:
- EN-Ji; 30
Name of Park: --'>Irl # 1110bt1e Id nyt /--rik Lot Number:
Parcel: __pl 0 5'-fk 00 2 PIN:
X- SW DW TW (Size x-72J# Bedrooms Year
Power Company (For Progress Energy we need the premise number.)
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.
You signature below certifies that all above in matio is rect.
C
Signature of owner or authorized agent: INN
NOT SIGN BELOW - FOR OFFICE USE ONLY
ation of Existing System
Signature of Environmental Health S
Date
7//0/o 9
S
SEPTIC L121
4/08
Specific Directions to Job from Lillinpton: