ETILA 11
LO Application #
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: TV\roc 4-. 1 Date: 1 I J
Address:
Telephone: 1 — 3zJbY- S`, vc
Property Own
Lot Address:
Name of Park: lc�vn�� 5 � � e t'6 }c 44-5 Lot Number: 6
Parcel:0q q 55.E PIN: = �S '%p (�— "MUM
_SSW _DW _TW (Size _Lq__xLD�) # Bedrooms _ Year__\,.,Q L
Power Companyk Q. kcr_A 'Et Q.C. (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillinaton:
2611A-7 --nnL a+�S 14:1\fAon_G-rr3.IP c� r5,y Cc•.c_c; Lv�
L�..A1 JC%�r .. i
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
Signature of owner or authorized
DO NOT SIGN BELOW — FOR OFFICE USE ONLY
Signature of Environ
SEPTIC
Authorization of Existing System
Specialist
Dale
4/08