ETApplication #
Harnett County Central Permitting
PO Box 65 Llllington, 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: J
Sl�tey (�ras>�ct� Date, S ��
Address: 9 a 1-5- TTurn�r L✓�o�)� f7�'Uc �d <<�'9� /(/C a %�U3
Telephone: Qi 1 q �) VS Q �a
Property Owner:
Lot Address:
Name of Park: _
{�(a(Iarli Rea1� 1.LC Phone: qrg
I1 _ i 1- r r ra„av liana
Lot Number: 4 g
Parcel: tr n / Gr OU i r� PIN: U!2� 2,2 O Z2� • D U
SW DW TW (Size # Bedrooms 3 Year
Power Company: (d3 yr (C (For Progress Energy we need the premise number -
There is
the
Intended a use offtthe septic charge or this system changes, or or of falseon Is Informationtisopro deIf
d On this
application.
You signature below certifies that ail above information is correct.
Signature of owner or authorized agent: a�
DO NOT SIGN BELOW — FOR OFFICE USE ONLY
Authorization of Existin System
of lnvironm ntai Health Specialist Date
SEPTIC
4/06
5/(0//l0
Al