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Application #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
91 Q -893 -7525 Fax 91 0- 893 -2793
www.harnett.org/permhs
Application for Existing
Applicant Name: —t'r_ 62
Address:
Telephone*
Property owner:
Tank In a Mobile HOMO Park
Lot Address: --J
Lot Number:
Name of Park
PIN: ?
Parcel:
SW DW TW (Size #Bedrooms Year--Z-J-��
Parcel:
_ — For Progress Energy we need the premise number.)
Power Company:
There is a $I o0.00 charge for this service. This certification is subject to revocamon 11 L11v
Intende d use of the septic system changes, or It false information Is provided on this
application.
You signature below certifies that all'above information is correct.
Signature of owner or authorized agent:
4/08
SEPTIC