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ETApplication # m Harnett County Central Permitting PO Box 65 Lillington, NC 27546 910- 893 -7525 Fax 910- 893 -2793 www.harnett.org/permits 8nniinntinn far EYistinn Santis Tank in a Mobile Home Park Applicant N Address: c Telephone: Property Owner: ,f� Phone: Lot Address: f l* a Al Name of Park: Lot Number: / Parcel: dY ��, !f `�� PIN: 12 4 ©(? _,�_SW DW TW (Size x 7 # Bedrooms_ Year Power Company: (For Progress Energy we need the premise number.) Specific Directions to Job from Lillington: /\ -�; j N Lcl /i% 4 Y f d r1 J' o f � i fD r% A! G 65 /e-IV C; a Rd 4o a Q iff 7 n 1^� AALt &9 L n. +D 10 t 19 o Yl r l'e !ref- 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 Signature of owner or authorized agent: SEPTIC DO NOT SIGN BELOW - FOR OFFICE USE ONLY Authorization of Existing System / u.o, ,ec'1 / /i (/7 12Z 1 y Signature of nvironmental Health Specialist Date `C' 4/08