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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