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ETApplication # d S ` � "" `i t Harnett County Central Permitting PO Box 65 Lillington, NC 27546 910-893-7525 Fax 910-893-2793 www.harneft.org/permits Applicatio for Existing Septic Tank in a Mobile Home Park Applicant Name: +- uA a Date: ©k q zjo 1 s Address: l-� N Po i =�l � / ,111-,n 1-Q 1--� (-? `K 2 5 G Telephone: q10- 2.'�S1 I Ar)-A-�- v-,4 K CA�-a1- 114( -11' - Property Owner: Lot Address: -A Name of Park: t2 Parcel: SW L/- S TW (Size 2--;� x - -L J # Bedrooms Year " eDrJ 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. I You signature below certifies that all above inform i."prrect. Signature of owner or authorized agent: DO NOT SIGN BELOW - FOR OFFICE USE ONLY Authorization of Existing System Signature of EnvironmetrtAfXealth Specialist SEPTIC ate 4/08