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ETApplication #j3- 5 32 1P. Harnett County Central Permitting PO Box 65 Liliington, NC 27546 910 -893 -7525 Fax 910- 893 -2793 www,harneft.org/permits Application for Existing Septic Tank In a Mobile Home Park Applicant Name: T� &c c&.3S Date: j U - f - 1 3 Address: 7 h r 1th M Ili, Ale 1 ue f Telephone: `T 1 1 E -(� 6 0-6 11-0 P Property Owner: N W n erg )V Tat' Phone: Lot Address: l-w t n 5f- Name of Park: R N-T- M �r ��, brne, Lot Number: o, 1 Parcel: . gS �? �� PIN: SW DW TW (Size x # Bedrooms cY Year Power Company: {For Progress Energy we need the premise number.} Specific Directions to Job from Lillingtoon: There Is $100-00 c arge for this service. This certification is subject to revocation if the Intended use 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: I ^� &a-4w �A �6 ajv'0�0' DO NOT SIGN BELOW - FOR OFFICE USE ONLY Authorization of Existing System iv Signature of Environmen eaith Specialist D to SEPTIC 9 6 a 4/08