ETApplication # (0�(1(�3�\�JSZ�
Harnett County Central Permitting
PO Box 65 Ullington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/parmits
Application for Existing Septic Tank In a Moblle Home Park
Applicant Name:
Address:
Telephone:
Property Ow
Lot Address:
Name of Park: 1720 Lk-- I r L/2" IJ—Y—` r' t Lot Number:
Parcel- I22fJ LQ O C7 PIN: . UOQ
/�, # Bedrooms 2 Year sR g
�SyV _DW _,TW (Size 1 ` _xl
Power Company.(For Progress Energy we need the premise number.)
There is
ct
vocation
the
Intendeda ste of the septico
osystem changes, s iscertification
IfHfalse lInformatioen Information f
provided onthis
application.
You signature below certifies that all above information is correct.
Signature of owner or authorized agent:
DO NOT SIGN BELOW — FOR OFFICE USE ONLY
Authorization of Existing System
4ate—
of
b
Environment I
osko
s
4/OB
SEPTIC