ETApplication # _l�l�(� �� -Ih-
Harnett County Central Permitting
PO Box 65 Edlington, NC 27546
910-893-7525 Fax 910-893-2793
www.hamett.org/permits
Application for Existing Septic Tank In a Mobile Home Park
Applicant Name: 1'a'L
Address:
Telephone:
Properly Owner:
Lot Address: -
Name of Park:
Parcel: PIN:
�gW _DW _TW (Size
_x, 71 l # Bedrooms Year 1�1�1
Power Company
(For Progress Energy we need the premise number.)
�pprific Directions to Job from Lillinoton: r ^ / / r , ) -L P,4
S
Intendeda seO the Septicosthis ystem chlanges,lorf falseon is subject InformationIsorevocation f
the
provided on this
application.
You signature below certifies that all above information is correct.
Signature of owner or authorized agent: n ��
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
re of Environmental Heafth Specialist Date
SEPTIC
5/0V/0
4M Al