ETApplication #
Harnett County Central Permitting
PO Box 65 LUlington, NC 27546
910-893-7525 Fax 910-893-2793
www.hamett.org/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: Date-
4A
Address; 440 2, a2 G
Telephone: v"6
Phone: a '"
Property Owner: -'
Lot Address: --
Name of Park:'QLot Number:
Parcel: tl2 PIN:
SW _jZDW TW (Size 2 x 7p } # Bedrooms _ . ,_ Year
Power Company: (For Progress Energy we need the premise number.)
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:
Authorization of Existing System
C Li —7//dZ •.r...L_�
4Signure of vironment I Health Specialist Date
SEPTIC
eros
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