ETApplication # /3�._pl�
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www,harnett,org/permits
Application for E sting Septic Tank in a Mobile Home Park
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Applicant Name:
Address: V /- S -i 'd V
Telephone: !':2 g� , Ji�E,2-
Property Owner:
Zw. Phone:- � 9
Lot Address: ,
Name of Park: '65 Xot Number: , Zu'L
Parcel: j PIN:
✓S'SW —DW TW (Size -ZL4_x g� #Bedrooms 3 Year-ZV-f--
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Power Company: ZV
, _(For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
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76- -2-a6c-dA�A&7-
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There is a $100.00 charge for this service. This cemrtl/lc von 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: /Oyy,, -e-eA 4411 1
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DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of ExIsti g System
3
tu'. of Environmental Health Specialist Date
SEPTIC 4/08
1113 All
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