ETApplication # I t � —o
Harnett County Central Permitting
PO Box.65 Liliington, NC 27546
910- 893 -7525 Fax 910 -693 -2793
www. hamett.orgVpermits
Application for Existing Septic Tank In a Mobile Home Park
Applicant Name: Date:
Address:
Telephone:
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There is a $100.00 charge for this service.
Intended use of the septic system
application.
You signature below certifies that
Signature of owner or authorized
00 NOT SIGN BELOW – FOR OFFICE USE ONLY
Authorization of Existin System
re of Environmental Health Specialist Date
SEPTIC 4108