ETApplication # If ✓ ~ 4r
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www. harnett. o rg/perm its
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: ~/Date:~ f % o
Address:
Telephone: 7 S Z(,
Property Owner: f f ~ C " ( Phnna• Ol9 - ,f'9 r 41z116
Lot Address: X g ,'(k' e-
Name of Park: ,C,4~y f~>~~/~ p Lot Number: *'/.5-
ParceG- /4 a5FIF PIN: O~-S - f .avO
SW DW TW (Size ~x S -2 # Bedrooms „z Year/99J'
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 information is corr ct.
Signature of owner or authorized agent: 1"
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
' c
Signature vironmental Health Specialist Date
Power Company; U'i oArrss ~~Py9 (For Progress Energy we need the premise number.