ETApplication # (Q ' 5 C C, fn K5 `)�
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
,
Address: �t
Telephone: '110
te- I Le -e, JV IS
�H,ZS-Ib
Property Owner: Wt('6tr1q
ZnGPhone:
QICt"a3S-RC&S
Lot Address: 1O6 kl no,
Ave, ('.Q Mon r,
A ,I-
Name of
Park: k%143 h4 N1 MHP Lot Number: fS
Parcel: t t 1> > ✓� 2 PIN:��J�
DC SW DW _TW (Size
�^Iq'-x `10) # Bedrooms 2 Year 1481
Power CompanyLCg,A}2!9 �'(+aC4<'"-CG (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
27 2A/ -ID 4 1917 1qC- lCot J I �,ur>✓ !�
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 IrItorgation is correct.
Signature of owner or authorized agent:
Signature of
SEPTIC
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
4/08
V1
S