ETHarnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnen.org/permits
Applicant Name:
Address:
Telephone:
'Zto t~
o1crE
Application for Existing Septic Tank In a Mobile Home Park
r n
Date: /
"U - 'IA 91/
Application # o- Soo-2-3 8
iA
Property Owner: ~a m i e.
Phone: Z2 2 - 9y
Lot Address: .
/2 y ,,-,l! ~ / A S 4 Ae
A X390
IC ~
Name of Park. ~ '
_..~Trrv /q~ter
Parcel:
Lot Number:
PIN:
/SW _._,DW
TW (Size fix- # Bedrooms Year. Jx
Power Company: el " I /I
(For Progress Energy we need the premise number.)
Specific ~i/rections toJob from ~illinaton:
'r / . /SRI'
There Is a $100.00 charge for this service. This certification Is subject to revo
Intended use of the septic system changes, or N false information Is rovid lion if the
application. P tied on
this
You signature below certifies that all above inf ation is correct.
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
U
4S* ture of E iron Health S
pecialist Date
SEPTIC
149q /lo
.S
4/08