ETA NN lication # / 5-00 5
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 Tank in a Mobile Home Park
Applicant Name: �t t ! `�'"h A-. L L U Date:
Address: 1.).)Ll '1,A 1PPU i �2.r� ��5 k arte �))gnrx _n C.. Zk;33q
Telephone: q
Property Owner: Phone:
Lot Address: S` y R et .. i)u on n c- Z � 3.3 c/
Name of rk: C()�� 1`) -4400e v)e �o v k- Lot Number
Parcel. —e') tl PIN: 1 Z7! 000
i/ SW DW TW (Size 11-P x } # Bedrooms 3 Year Dl
Power Company: (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
Ion
C1,054.
Lo-� i 5 tan r i ght
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 in�gn)ation is correct.
Signature of owner or authorized
DO NOT SIGN BELOW – FOR OFFICE USE ONLY
Authorization of Existing System
I ature of Environmental Health Specialist Date
SEPTIC
�;' "N�.:.
4/08