ETApplication # _ ( S"
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793 c
www.harnett.org/permits
Applic io f r Existing Septic Tank in a Mobile Home P Irk
A 'r 1 -
Applicant Name: i- v �� , y , L Date: 20 I S
Address:
Telephone:
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Property Owner. , �_ � � Phone: 't t1- ZBs-1
Lot Address:
Name of Park: �� i� J �,,-� ,.4� ti��„� {,��,,., r,.�Lot Number 2
Parcel:C�-1
SW DW ---TVV (Size Z-�K x -T # Bedrooms 3 Year cy� 2
Power Company: (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 i
Signature of owner or authorized agent:
SEPTIC
DO NOT SIGN BELOW — FOR OFFICE USE ONLY
..Authorization of Existing System
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Signature of Environrti. tal Health Specialist 1 D to
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4/08
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