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Address: Application # ©R -qnp-ZZ`i $ 6 Harnett County Central Permitting S NED PO Box 65 Lillington, NC 27546 tat t34 910-893-7525 Fax 910-893-2793 DATE www. harnett.org/permits Telephone: `1' Kul - - ~k - (I A9 ( Property Owner: Phone: kQ -'2% 4 N Lot:Address: ► C~ yr~•pt~~ fame of Parkes Lot Number: -P me 317 I(V 1(- 2 0.-3,31, oocD ¢a{{,~: BYI " t 5 Fri- _ ~ E79 0 2-9 i SW DW . TW (Size N x y7 # Bedrooms ,--3 Year ~i Power Company: CQ -tZ-S 45) (For Progress Energy we need the premise number.) Specific Directions' to Job from Lillingtton: 9-7 A a,43 , _ t ~ 'D rJ 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 abov information is correct. gra„~a;f owner or authorized agent: DO NOT SIGN BELOW FOR OFFICE USE ONLY Authorization of Existing System io-8-d5 ignature of Environmental Health Specialist Date /z~ SEPTIC 4108 Application for Existing Septic Tank in a Mobile Home Park