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Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910.393 -7525 Fax 910-893-2793
www.harnett.org/perrnits
Application for Existing Septic.;Syst,em Inspection in a Mobile Home Park
Applicant Name: ��Fc. -Date: alit /14
Address:
Telephon(
Property Owner: 4� C C&r Phone:.
Lot Address:
Name of Park: Lot Number:
Parcel: PIN:
8W _DW TVV (Size x____:_) #Bedrooms Year
Power Company: .(For Progress Energy we need the premise number.}
Specific Directions to job.from LilliagLo_n:
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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 on1his
application.
You signature below certifies that all above information is correct.
Signature, of owner or authorized agent:
?JOB
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