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ETApplication # ©~l 5 o a Z 25~ L7 Harnett County Central Permitting NEB PO Box 65 Lillington, NC 27546 r09 910-893-7525 Fax 910-893-2793 4~0:- I www. ha melt. org/permits DATE. Application for Existing Septic Tank in a Mobile Home Park Applicant Name: James R. Hughes Date: 08/05/09 Address: 809 McArthur Road, Fayetteville NC 28311 Telephone: 910-488-8756 Property Owner: James R. & Eddie Hughes Phone: 910-488-8756 Lot Address: 35 Jersey Lane Name of Park: O & H MHP Parcel: N o5 S5 X11 ,/1, 14 Lot Number: 18 PIN: co514--15-50Sl,000 SW DW TW (Size X OU # Bedrooms 3 Year 1993 Power Company: South River (For Progress Energy we need the premise number.) Specific Directions to Job from Lillington: Take 210S go aprox 10mi. T/R on Bill Shaw Rd. Go 1 mi to stop sign. T/L on Overhills road. Go aprox 1mi, T/L on Jersey lane. Lot is directly in front. 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 information is correct. Signature of owner or authorized agent: Signature of tion of Existing System V-J Specialist a I- J) l Date ftloqs SIGN BELOW - FOR OFFICE USE ONLY SEPTIC IN M.H.P. 1109