ET)0-7 Application # ~?-IaDOC54
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-893-7525
Fax 910-893-2793
Date:
AppliG
Addre:
Teleph
Property Owner: d F
Lot Address:
Name of Park: - Lot Nu
Parcel: PIN:
4SW DW TW (Size x~~ # Bedrooms
Specific Directions to Job from
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 information is correct.
Signature of owner or authorized agent l h'1
SIGN BELOW - FOR OFFICE USE ONLY
Signature of
of Existing System
'2-S
157
ate
&/07
f
Application for Existing Septic System Inspection for a Mobile Home Park