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Application #_J~
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:
RA I t/te
Adx
Address: /~Dt Date: ff-do - /O
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Telephone:
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Property der: 1grr
Lot Address: r4/y~jt vj- J. (/Z_iO)J Phone: y/q4
Name of Park: r~1.
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An~~cs b;~ ~lv.
Parcel: ~'j'I U 7 Lot Number:
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Power Comp an o } # Bedrooms Year--1_
p y ~ an ~~f~q ~ (For Progress Energy we n
Specific Directions to Job from Litlinpton: y~ ~ y~ need the premise number.)
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D~~ Lam. - ~ C0 Cr ~11 ~ !ZG
There is a $100.00 charge for this service. This certification is subject to
revocation
Intended use of the septic system changes, or if false information is if the
application. Provided on this
You signature below certifies that all above information is correct.
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
re of Environmental lX_ ~Q
Health Specialist Date
SEPTIC,
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