ETApplication #
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 Ina Mobile Home Park
Applicant Name: T vt c_a MA , r" _ -- t -7=Z r� �
Address:
Telephone:
Property Owner: �A F-f Phone:
.Lot Address: -'�- ��l_ � MeA et -L.. s4, PL/1 n n
Name of Park: Lot Number:
Parcel: 14. PIN:
-IL -§'W DW TW (Size J± x^ } #Bedrooms __ 2_ Year '7 7
Power Company: '- xaCZ td T21 (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillinglon:
46 J 5- 47:51 VOQ&44&a12� d(4ard4 2b
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. ----I
You signature below certifies that all above information is mfr
Signature of owner or,authorized agent:
Authorization of Existing System /
%nature of nvironmentai Health Specialist Date
SEPTIC 4108