ETApplication # 13 !? o 32 3
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910- 893 -7525 Fax 9 i 0- 893 -2793
www.harnett.org /permits
Application for Existing Septic Tank In a Mobile Home Park
Applicant Name: I�e lcC1��- Date:
Address: 2 3sl e e l ,e6 S�
Telephone: 1 1 ,:2 7 C} ` 7
Property Owner: C_-%�` Phone:
Lot Address. �' `fir
Name of Park: Lot Number:
Parcel. 9011 PIN: _
X SW DW TW (Size x # Bedrooms LWi-- Year
Power Company' (For Progress Energy we need the premise number.)
> ific Directions IQ Job from illin on:
O I-- 4 - l-zi
., I . J — - -
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 inform
n is correct.
Signature of owner or authorized agent:
DO NOT SIGN BELOW — FOR OFFICE USE ONLY
`Y -.,_, Authorization of Existing System
Signature of Environmentart4okh Specialist D ak e
SEPTIC
�L90 ,
4/08