ETApplication #_ 1 O 5o of) A%
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:
Address: uo
Telephone: a, C
Property Owner:
Lot Address:
Name of
.r�—i of 0
Par I: I U • , () 10 (tl) PIN: UStDF
SW _DW _ (Size xUO) # Bedrooms I— Year_2LL(,I�
Power Company: (((. (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillinaton:
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 H false Information Is provided on this
application.
You signature below certifies that all above information is
Signature of owner or authorized agent:
DO NOT SIGN BELOW – FOR OFFICE USE ONLY
Authorization of Existing System
c*A S
SEPTIC
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