ETApplication#
Harnett County 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
Applicant Name: Krrnooinun (-CC Date: ,(),4---i- k 3
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Address: a "I CY, \i t9 0
4
Telephone.' q1Q CY= 2 k 5
Property Owner:
Lot Address: - &,
Name of Park:
ne - C'i i D <A I)-) -
Parcel:
Power Company-,
PIN:
TW (Size_x) #
x Bedrooms Year
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Specific Directions to Job from Lillington:
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 inform ti is C07 Ct.
Signature of owner or authorized agent:
Authorization of Existing System
l"I
Signature of Vironme'ntal rHealth Specialist Date
SEPTIC