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Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
vwvw, harnett.org/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: , -K. - ; 1
Address: j 95 l Dated?
e
Telephone: r" ~C
Property Owner: A m i r
LIV
Lot Address: 5 n Phone: F 2 -y~
Name of Park.
Parcel: Lot Number:
PIN:
SSW _ D
~~Tw
(Stze _x_joj # Bedrooms
Power Company=---.C ~ Year a? jo
~ef^ (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillino~ton:
~fO .Spin/ le T
IS h
There Is a X100.00 charge for this service. This certification 1s
intended
sub ect to revocation if the
application use of the septic system changes, or if false Information
, Is provided on this
You signature below certifies that all above inf
anon is correct.
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Auth 'nation of xisting System
4A6'on'
H Specia is ate /
SEPTIC
Application # 1 C) - 50 0 -23 (c,13 -Z
SCANNED
-t 1 D
DATE
r/a~ /ios
4/08