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ETApplication # U 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: �; u -M JIS r m & c �- M t- Date: 6 - ,? 5< 14 Address: % Y31 14wy. 8"7 So SQ ��: T/, ,r✓ 17x5 Telephone: 9/f Sl a 4 S S3 �— Property Owner: ,t d d Ga,� 06'-IfP6r d Phone: 9)n- 5,z9v �S3 z Lot Address: m' -c P &P,66( LoN Name of Park: Gam h ra l- m l r P Lot Number: Parcel:_C� e1 S7 (P dp�� PIN:9S%1-dS OS�ICn•�� 'SW _DW _TW (Size j_�( x w ) # Bedrooms Z- Year Power Company: Pro as C s GA/c R v (For Progress Energy we need the premise number.) Specific Directions to Job from Lillinoton: q{,2 / Al - r L oy o v % /rolacd �a - SG✓a� hN S✓a �.a. aq� /Z - S M/l/ C J a V A!2 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: SIlZ ,B. .� r DO NOT SIGN BELOW - FOR OFFICE USE ONLY Authorization of Existing System Ie I e`alth Specialist Date SEPTIC 4/08 51',x// S