ETApplication # _e2
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
Application for Existing Septic Tank In a Moblle Home Park
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aa~e,of..Par- iu {may ~io~,`/~ eta %Q et ty t Number:
Parcel: PIN:
Power Company: (For Progress Energy we need the premise number.)
S ecific fr m Lit in on:
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There is a $100.00 charge for this service. This certification Is subject to revocation It 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: :,Y c_
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
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gnature of ' onmental Health Specialist Date
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4/08