ETApplication # I WSW 0 l5
Harnett County Central Permitting C oI 3 L
PO Box 65 Lillington, NC 27546 1 — I— al -I
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name:
Address: rD 6DY 51y5 Son hxd NC-
Telephone:
CTelephone: Lq 1q) T15 -q Si q
inc. Date: 1-aI' Iu
Property Owner.6I
ndlnGRld4e PraLxnc�t,%nc
Phone: LQIq)775-g59-9
Lot Address: 8(p
Ch
Kinc nrlc„C LIC', Cameron,
NC. -;I L"
Name of Park: Knolh;rx
-GP) MN('
Lot Number: L4
Parcel: Oqq 55h
Uu34ca
PIN: L1555 -Lo I -a]
49
✓ SW DW
TW (Size I`-{ x)
# Bedrooms 2 Year
198tD
Power Company:
Cenfro l
(For Progress Energy we need the
premise number.)
Specific Directions -to Job from Lillington:
IctKC, �IWu dI Ou+of IJWihatan 4v Nc- XJa-7 -turn n�W Go about
1 4 n,�les i -urn I(:, -ft 00fC) MC-Ico\�tovyn RC. Go Cib)ut' a Ingle Culcl
-kirn ICFs onto Ktna ChCrIts Ave
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 information is correct.
Signature of owner or authorized agent: /%, '-,
SEPTIC
DO NOT SIGN BELOW — FOR OFFICE USE ONLY
uthorization of Existing System
Signature of Environment I Heath Specialist Date
J1v2 AAA-
2 -
4/08
/tai// b
5