ETA pp lication
Harnett County Central Permitting
P4 Box 65 Liiiington, NC 27546
910- 893 -7525 Fax 910 - 893 -2793
www.hamett.org/permits
for Existing Septic Tank in a Mobile Home Park
Telephone: `1q, -6-86 .5'I ,:r3
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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 jor mat on is correct.
Signature of owner or authorized agent:
DO NOT SIGN BELOW -- USE OFF USE ONLY
Authorization of Existing System
gnature of Environmental Health Specialist
SEPTIC
rt -r
Date
4106