ETApplication # Oq 5 oG 2 Zloe~
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546 SC NED
910-893-7525 Fax 910-893-2793 S t~
www.harnett.org/permits DM
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: Howard Rogers Date: 8/19/09
Address: 158 Caley Drive
Telephone: 919-557-5626
Property Owner: Preston Blanchard Phone:
Lot Address: 158 Caley Drive
Name of Park: Mill Creek Village Lot Number: 42
Parcel: 05 0635 0323 PIN: 0635-65-6610.000
/SW DW TW (Size 14 x 64 # Bedrooms 2 Year 1984
Power Company: Progress (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
Take 401 N. T/L at Mcdonalds. T/L on Christian light road. T/L on Cokesburv. T/R nn raliqv
Drive.
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 co ct.
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
f3-ZL-D9
gature of nvironmental Health Specialist Date
/09 Al
SEP71C IN M.H.P.
1/09