ETApplication #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910- 893 -7525 Fax 910- 893 -2793
www.harnett.org/permits
Applicant i . ♦ t
13 0
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Telephone: e
Property Owner: sietiA Phone: qzT. M- 965*3
Lot Address:
Name of Park: f dark k Lot Number: j
Parcel: PIN: 11yr. 000
SW ✓ DW TW (Size .2Zx Sa) # Bedrooms _ Year 19 2 ?
Power Company; (fev` r*.) Elec.tc— (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
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 correct.
Signature of owner or authorized agent: I =, i .---°—
Authorization of Existing System
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ignature of Environmental Health Specialist Date
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SEPTIC 4/08