ETApplication
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www. harn eft. org/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: Date:
Address:
r-.
Telephone: I0- -
Property Owner: IC
Lot Address:
Name of Park: _ L c(ak e' , LAA--10
Lot Number:
Parcel: 651-' 16 PIN: /l -
0~ 'o'-r'
7 p.~
T"W DW TW (Size -x`~O) # Bedrooms -3
Year
Y
Power Company: (For Progress Energy we need the premise number.)
Y
Si
C,~~
J~,, ( l~~ i / i G
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.