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Application # to-
Harnett County Central Permitting
8 o~A~ PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www. harnett. org/perm its
Application for Existing Septic Tank in a Mobile
Applicant Name: /-I,- - , ~
Address:
Telephone: _ Q!9 - c] ~a _
Property Owner:
Lot Address:
-Z~ 7 g
Park
Name of Park:
M H P Lot Number: ,
Parcel:
TW PIN:
->a-SW DW
(Size # Bedrooms
Power Company: Year
(For Progress Energy we n led the premise number.)
S ecifi Directions to Job from i .u..,,,+ 1
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 thi
application. ! this
You signature below certifies that all above information is correct.
Signature of owner or authorized agent: _ 4/] ."4~2
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
nature of Enviionmental Health Specialist' n
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