ETApplication # l4b3r7
Harnett County Central Permitting
PO Box 65 Lillington, INC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: W fad i n 9 Ring] A�'Onrnbc� -roc. Date:
Address: PO &X s145 .coof nd, tic a'f3a1-5i4.5
Telephone: glq --1"15-g5S59
•p" • . t• Phone: • • • •.
Name of Park: urnorhnQhcrn MHP Lot Number:
Parcel: b gq 655 M340a PIN: 8666 -u I - Q-7 49
/SW _DW _TW (Size 1,x `1b ) # Bedrooms 3 Year 089
Power Company: Cen Wal UeCtnc. (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillinaton:
-TCLKe 14WV 21 but PrP li l l Inr4fan ;D N C- 141--o tu(r) 06KI. -1, i b
I - 4- m I le, S h e e n lef'+ on -b Mci<r4 4nu i n Rd C o aho-Ld a m l l t an rJ
ktwrl left onto I�inG C�r,rle.� Aqc,.
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 infprmation is correct.
Signature of owner or authorized agent:
DO NOT SIGN BELOW — FOR OFFICE USE ONLY
of
Authorization of Existing System
Health Specialist
iy rQ )
Date
SEPTIC 4/08