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SEPTIC Application # /05 5 2F 2 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: k ' CL - UV'\ \ \' ( Date: \Q —\ - lCTh Address: ( )311 CO LA q D \ H ■ l l� kiN 2= (D Telephone: "1\ ; (Lt '- z (0n'I L Property Owner ��,, Add 5 \ h iPs- hnnpn4 LJ.,�p , Phone: .MPJ " Lot Address: PI r f VST SA ` Name of Park: ©C 1CCta\ JA AP Lot Number: lb Parcel: £7 /6 /2 0, 29 PIN: I�O / U — Ire f30O4' SW DW TW c� Size rr� x ( ( r—1 ��) # Bedrooms 3 Year Power Company: (For Progress Energy we need the premise number.) Specific Directions to Job from Lillinoton: C -- 1 - 4/0/ O A Q ()COs - \owot vcis 'R Qb ssn rn \es bn 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 i f mat is / Signature of owner or authorized agent: i /_ ^� ' ' ' .AL DO NOT SIGN BELOW — FOR OFFICE USE ONLY Authorization of Existing System Signature of Environmental Health Specialist Date SEPTIC 4/08 - //7 2)j Nfd' xc riv / r r `,- h 5 p r e 4 "., u,,, ax , k *a,e+exc< sn r v t"aWmr i c,- : tE � <� v �,a > t -tl w ... a• / R.� nh t y � "^ r ^ m r (r t r �' Y ' ti v r ra ' c „ � _ I�� ',t /, , < STATE OFWNORTH C :� t a y y�ir�� a �, � � rw t: rf �� .'; �i f -_ i [ 1 �l-£ �i^ asrs"' v�3f�vcrs "`�'£'.w�s Y- ' °'� < �" ' N . .! ` / t p. - 1 . ..• cid � P aC. `a ' - ' MVR 19 t (Rev 05/07) :b `^ir * 1 CERTIFICATE OF TITLE a, ° �� VEHICLE,[DENTIF[CAT1ON t`.IUMBER , Y EAR MODEL MAKE BODY STYLE �� r I Y,� NCFLL41:A16759V0;:: 1990 VOGU MH I'� - . 0 TITLE NUMBER TITLE ISSUE DATE PREVIOUS TITLE NUMBER, ,` , ; 08/17/2010 774334490968155 I � 1 r 0 1sI ( ill yiur' rifI tsili' rilriluilnrilrirlildtfiurlOtflliirti O F ODOMETER READBJG i'/ RICK'S INVESTMENT PROPERTIES, LLC : � `,� yr B 3371 US 40:1 N - - � ' , Q ODOMETER STATUS t 3 ; r, g LILLINGTON NC 27546 ;','' I . TITLE BRANDS ✓{t =; t .,,.. r - ) OWNER(S) NAME AND ADDRESS ".� i RICK'S INVESTMENT PROPERTIES , LLC � 1 3371 US `401 N h� i C " � 1 P L ILL INGTON NC 27546-71,59 { i 11111111011111111111111111111011111131111�11111111nnIf0IIIFif1111ft ! m a e � The Coin re tni9Slouer of Motor Vehicles of the State of North Carolina hereby certifies that an application for a certificate of title for the herein described vehicle K ' if f a i has been filed pursuant to the General Statutes of North Carolina and based on that application, the Division of Motor Vehicles rs satisfied that the applicant ` 3 ^' � I is the Iawfiil owner. Official records of the Division of Motor Vehicles reflect vehicle is subject to the liens, if any, herein enumerated at the date of issuance 'j of this certificate. r'r ii (J As WITNESS, his hand and seal of this Divhsioa of the day and year appearing in this certificate as the tide issue date. • k . ., l € C MISS[O O OT ICT.ES 4t .,. ,, ,, ,. FIRST LIENHOLDER DATE OF LIEN ,, s- "s - LIEN RELEASED BX P . Ft" lr r a- 'k. SECOND LIENHOLDER: DATE OF LIEN t ✓'� - ' - LIEN RELEASED BY: pigs ( t - SIGNATURE — - - - -' -- Rt z' �p,,��rrI TILE___ ..DATE__ °a. THIRD LIENHOLDER DATE OF LIEN , 9' i LIEN RELEASED BY: , SIGNATURE � � €I g, FOURTH:LIENHOLDER. DATE OF LIEN F $g} LIEN RELEASED BY. — _ __ I � ��,�n SIGNATURE a' 00 y 1' +yul2 9TI'LEv__ — __ --DATE �� 8 X if ADDITIONAL LIENS It ; 155 T1C1551 o r ' 6m — T _arT.s. aez ws�mVad m .LOTm.sma .ssv 4 : a . ` tin AN ALTE OR' RASURES VOID TITLE 'C ' f ?