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Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www. hamett. org/permits
Applicant Name:
Address:
Telephone:
t IL 0 t,0
DAM
Property Owner: e
Lot Address: L Phone: ~ 2 -yV 9,1
r I pv
Name of Park: ~Y._:~ctr s /79 //,l
Lot Number:
Parcel:
PIN:
- SW ~DW 7'W (Size AX?p a # Bedrooms 3
Power Company; Year
(For Progress Energy we need the premise number.)
ifi Dir tin t fr m Lilli n:
Ile 164-
-71 ~15 ~/"-111
There Is a $100,00 charge for this service,
Intended use of the This Certififalscation Is subject to revocation it the
application. Septic sYstem changes, or it e information is provided on this
You signature below certifies that all above inf ation is correct.
Signature of owner or authorized agent:
00 NOT SIGN BELOW - FOR OFFICE USE O1VLY
Authorization of Existing System
JSi~ azure of Envtron ealth Spec' lis Q?
Date
SEPTIC
Application #
I o 5 Go -Z3 Qj
s
4/08
Application for Existing Septic Tank in a Mobile Home Park