ETcD - IL4 Application # I L4 �J `S S(j -76
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www. harnett.orq/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: Anderson Creek Mobile Home Park _Date: May 15, 2014
Address: 17 N. Peggy Street, Spring Lake, 28390
Telephone: 252-714-3458 (Ed Perm)
Property Owner: Anderson Creek MHP, LLC Phone: 252-714-3458
Lot Address: 44 N. Brenda Street
Name of Park: Anderson Creek Mobile Home Park Lot: 106
Parcel:C)\ 6SlSbj>W7 PIN: --7L4L4q,W6
XX SW DW TVV (Size 14 x 76) # Bedrooms 3 Year 1999
Power Company: (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
Hwv 210 S from Lillington about 10 miles to Overhills Road. Turn right. Go about 4 miles
to Archie St, Turn right on Archie, then left on Carolin then right on Brenda. Lot is 3d or
4th lot on right
,/J,ft�y
There is a $100.00 char -ge for this service. This certification is subiect to revocation
if the intended use of the septic system chancies, or if false information is provided
on this application
Your signature below certified that all above i ormation is correct.
Signature of owner or authorized agent:
SEPTIC
DO NOT SIGN BELOW — FOR OFFICE USE ONLY
Authorization of Existing System
r/ Z I I-Zolq
Date
4/08
vironmental Health Specialist