ETApplication #
Harnett County Central Permitting
PO Box llington, NC 32793 9 10-893-7525 5Fax 9 1 o-89
www.harnett-org/permits
Application for Existing Septic Tank In a Mobile Home Park
it
Applicant Name: ---
Address:
Telephone:
Phone:
property owner: Q I
Lot Address:
Lot Number
7
Name of Park:
PIN
Parcel- :2 Year
4, §W —DW (Size # Bedrooms
--------------- (For Progress Energy we need the premise number.)
power CompanyL
S ecitic Directions to Job from Lillinjq—n:
RUR!4���' - n --
NOT SIGN STMI
Authorization of Existing System
15
Date
-"�Iignal re, .1 �Enironme,, 1 /Health Specialist