ETApplication #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546 .
910 -893 -7525 Fax 910- 893 -2793
vwvw.harnett.org/permks
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: Date:
Address:
Telephone:
Property Owner: ts�z r� �' Phone: q1-7
�- 1
Lot Address:
Name of Park: � a /n /'-'S �` G �- Lot Number:
Parcel: O � q� PIN:
__A 8W DW TW (Size 1 p x 9-U) # Bedrooms Year
Power Company: (For Progress Energy we need the premise number.)
Specific Direc tions to Job from Llllinat :
2 / A / ,1 ,6101 G.(/
fi Ile
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: IL
` " ~�• , D NOT SIGN BELOW — FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Envirormenteith Specialist qate
al
SEPTIC 4/08