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Applicant Name:
Address:'—LV
Telephone;
Property Owner:
Lot Address.
Application #I d- -
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
Application for Existing Septic Tanik In a Mobile Home Park
Date.:,2/
SW >( DW TW (Size x_5y ) # Bedrooms Year
Power Company: Ce 4�141 j c•
_(For Progress Energy we need the promise number.)
SEPTIC
Authorization of Existing System
'Signature ' Environmental Health Specialist Date
4108