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ETApplication # - 5©c~ 233 Z Narn ett County Central Permitting PO Box 65 Lillington, NC 27546 914-893-7525 Fax 910-893-2793 SC NED Www.harnett.org/permits 25 ~E g/permits Application for Existing Septic Tank in a Mobile Home Park Applicant Name: Address: 2 y Date: ~f - Z OQ` l ` 10 of `-"GO Telephone: ~Gy C4,fl C Property Owner: Lot Address: Phone:~ ~ U Name of Park: Co u y ,KO y j 4- Parcel: o umber: _.ZSW DW PIN: - TW (SiZQ --~c-x_Iaj # Bedrooms Power Company: Year. (For Progress Energy we need the premise number.) tec-ific Directions to Job from Lillin ton: 2y z 1121, Y z 11110 u a ~ do a~ 11g, IL lam. c There is a $100.00 charge for this service. This certificate intended use of the septic system changes, or If false on is subject to revocation if the application. Information is provided on this You signature below certifies that all above information is Corr Signature of owner or authorized agent: correct. DO NOT SIGN BELOW -FOR OFFICE USE ONLY Authorization of Existing System ronmental Health Specialist z 2ou Date ~17~~log SEPTIC 108730