ETApplication
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:
Address:
Telephone: -
Property Owner
C1 : off ~-7-aS7
Lot Address: -
Name of Park: Lot Number.
Parcel: I PIN:
U SW DW TW (Size x # Bedrooms Year
D
You signature below certifies that all above in ation is correct.
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
rization of Existing System
QS tp JS
Signature of Environ i Ith Specialist Da
5/07
RAaofn, x , n if~
There is a $100.00 charge for this service. This cer0cadon Is subject to revocation If the
intended use of the septic system changes, or if f ise Information Is provided on this
application.