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ETApplication # 09 , 500 ` 227 (o D Harnett County Central Permitting PO Box 65 Lillington, NC 27546 PC NEED 910-893-7525 Fax 910-893-2793 3 o9 www.harnett.org/permits DATE Application for Existing Septic Tank in a Mobile Home Park 7GA4Iw^. Cty(.- Applicant Name: TG,. ),f Date: ey -a -©'A Address: 7 9 O 10A- C--, S ~l L;►; nr~a~ h G S y Telephone: _ 1:2t kq- y-99 - 7 c q Property Owner: &a4 ~Prs &-m4w,[s L(~ - Phone: Lot Address: r eT Name of Park: 1'v l ,`4-e Ae I I Pvnd -Ed n- -rs Lot Number: # I k Parcel: PIN: 0(030-149-5-Me.000 -4_SW DW TW (Size 1_x SC) ) # Bedrooms 3 Year ~C l _ Power Company: 5og A k ver (For Progress Energy we need the premise number.) Specific Directions to Job from Lillinaton: les Y'e(4 . o'p ~ " 1ov'- +krn (ic],4 oti 1a~ FJ'f1`n Pd, 90 wn 4 S=r h r q c //11 J T 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: DO NOT SIGN BELOW - FOR OFFICE USE ONLY i Authorization of Existing System Signature of8nvironniental Health Specialist Date SEPTIC Cos. (~i i# I o 2 519 9/a /p y S 4/08