ETApplication # 07 6r)(0 ~ -7 R
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-893-7525
Fax 910-893-2793
for Existing Septic System Inspection for a Mobile Home Park
Date: v 36 10 r
Applicant Name:
Address: o g-
Telephone:
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Property Owner.
OY1 Phone:
Lot Address: D NOI Name of Park: So ~ Lot Number.
Parcel: 105 1 -1 PIN:
SSW DW TW (Size I_x# Bedrooms Year
specific Directions to Job from Liilinq of n:
~i4 e O A , ~S VV 7"4/v 40, 4 7~ke g C oh,~►
ve.e ,•J I a ` 2 Jn ,-lc A o,, Ma
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 in ation is correct.
Signature of owner or authorized agent: L
NOT SIGN BELOW - FOR OFFICE USE ONLY
of Existing System
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Signature of
ate
SM7
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