ET RApplication #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnott.org/permits
leeApplication for Existing Septic Tank in a Mobile Hornr k
Applicant Name: (1, 4,_Date.
Address: el L,t u L
Telephone:
Property Owner: Phone:
Lot Address: /,"Li �':5 f'-) le I c U
Name of Park: � Lot Number:
Parcel: f Z/Y PIN:
SW DW ____TW (Size __x
i) #Bedrooms Year
Power Company Gi -(For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
t;L,. , t Z i k ; -
4q- 61 ? q -I "
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 inforTation is correct...
Signature of owner or authorized agent:
7 Authorization of Existing System
4117
Signature of t6vironmental Health Specialist Date
5,13b
SEP flC
"R
4/08