ETApplication
www.harnett.org/permits
Application for Existing Septic Tank In a Mobile Home Park
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Address: s L,
Telephone:
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Property Owner: .er�s �� c�,e s-' Phone:
Lot Address: /5—/ e �:,> '7,5-,:V.1
Name of Lot Number:
Parcel: 6 "77/ ion v 4l ) � _ PIN: 16 eV
-Z_SW DW TW (Size _6_x 7,? ) # Bedrooms 2 Year 9e/4e
Power Companyu�r£-•�-sS (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
1 r n lie o n S -/0 ct O(r-a/s C'oa f s-
_�"ur�x /e f f on 4 b or PW -
14 rA
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14rn /e�"fi on .7ohns¢�n C� .Rod ,burn 1���d� 13�fi1��1 Church
A-fi 0 n G -re
owe L_&-\,
There Is $100.00 • this service. This certification is subject to revocation if the
Intended - of the septic system changes, or if false information Is provided on this
application.
You signature below certifies that all above information is correct.
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Signature of owner or authorized agent:
SEPTIC
DO NOT SIGN BELOW — FOR OFFICE USE ONLY
Authorization of Existing System
gnature of Environmental Health Specialist Date
4/08