WETApplication #'--''t
Harnett County Central Permitting C 1 -7
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
Applicant Name:
Address:
Telephone:
Property Owner:
Lot Address:
one:
Name of Park: rAA W \ t- � �c A Lot Number: 1 �22
Parcel- &7 PIN:
SW DW TW (Size
X-10) #Bedroom Year
Power Company: -(For Progress Energy we need the premise number.)
Specific Directions to Job from LilliogjgLn:
You signature below certifies that all
Signature of owner or authorized agent:
1 -1101F, 11 N a &I Eel , J,
Authorization of Existing System
Oh�ature of Environmen flil� Health Specialist
-7 —/0 —,(S—
Date
SEPTIC 4/08