ETApplication # n 7 5 no E09
Harnett County Central Permitting
PO Box 65 Ullington, NC 27546
Telephone Number 910-893-7525
Fax 910-893-2793
Application for Existing Septic System Inspection for a Mobile Home Park
Date:
Address:
Telephone:
Property owner: Phone: U - `-1 ~ 7 -
Lot Address:
Name of Park: - Lot Number
P reel: PIN: ~FiiH - -
0 SW DW TW (Size x # Bedrooms Year f.
Speci
fic Directi
ons to Job from Ullinglo:
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U 110 -
tn kP. (e--) cc*p c~arnl~a'~t of Q
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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 in tion is correct
Signature of owner or authorized agent
SIGN BELOW - FOR OFFICE USE ONLY
of Existing System
~ q~5 1O is p~t
11 Signature of Environmental Hea alist Date
5/07
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