IPACApplication # Lp S �c v
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits lW�
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: y>„ , rR
Address: 'P_ 6:) kL�- 3 L (Lr Nc4 A6 Z7,5 5�-✓�
Telephone: —;; , 2 - -Z-i� C'
Property Owner. 1Z�v,rz, /tet -�p2'� Phone: Z5Z-2ffi ZzC
Lot Address: -7 1E¢vrr,3 -"M tJjtrt i_
Name of Park: "ANT lm t{ p Lot Number: q
Pa I: )Wss(O oaai0 PINS�(D'(i�' ��{ .600 eA
SW _DW _TW (Size �_x�) # Bedrooms �_ Year 1978 pd-a-Vf�`
Power Company: Q 5-rr)Lr (For Progress Energy we need the premise number.) jVq �
Specific Directions to Job from Lillinoton:
40 l 5 {o �u w� �L — l��[�ln-t Zn 'VP �CCuA C%rrpLf 14 ft t �2val�
Qtgl^T DAJ GSR- T?040 Pi)rlr— Lfsr-T LYO
t--Vum Vl,JZ&.1rk1c -5f. -9a-„ oT 01= czt�i - t�N[f rSN�S�T Up
Jus < a:ULLeD 4 C>ogP{L-a .
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 ofr
Signature of owner or authorized agent:
O NOT SIGN BELOW - FOR OFFICE USE ONLY
uthorization of Existing System
i 1J.
Signature of Environmental alth Specialist ate
SEPTIC
4/08
5