ETApplicant Name:
Address:
Telephone:
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Harnet�
ounty Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
Application for Existing Septic Tank in a Mobile Home Park
erne,. w i-i'e�s� Lam, Date:
2 it OA a
-5
-02345 or qfq - ✓�!o - �%
Property Owner: 14o m e- M �V T s e -r s Phone: !-,51AMe
Lot Address: 1-20 �; �� C
Name of Park: i'Yl +jc-V e t v,tip S Lot Number:
Parcel:__�j_j�� PIN:�_ - Lia - "Cjg' WD
SW DW TW (Size 1 Lf gU) # Bedrooms �Year -9(__
Power Campan15 c3,A-rz{ 12.„ (For Progress Energy we need the premise number.)
Specific Directions to Job from I illington:
i'r"� +UW AID S S�i1 s<C7E � t2 � yKT C" C0,11"', �d
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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 on this
application.
You signature below certifies that all above information is
Signature of owner or authorized
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
e
Sign tore of nvironmentai Health Specialist Date
SEPTIC
4/08
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