ETApplicant
Address:
Application# 1 + ��'��`+C(�5 1
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harneft.org/permfts
Application for Existing Septic Tank in a Mobile Home Park
Telephone: Q(0- W-Z2-q2o, Li (IA171 t C) 6,2 910- 30K -Q-7 ZLI
Property Owner: IF- � �15A145P-- & w'IYm I Phone: 8&11 E
Lot Address: 9 C� & 11f4l$ t.f\1
Name of Park: S-Ibk-1 i S IVJJP Lot Number: _ 0
Parcel: 10 O! a 624 00-5
\./SW DW TW (Size -LLL--x-&J # Bedrooms ) 2 Year
Power Company: sf-emG (For Progress Energy we need the premise number.)
Specific Directions to .. from Lillington:
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 is correct.
Signature of owner or authorized agent: C, ,---
NOT SIGN BELOW - FOR OFFICE USE ONLY
of Existing System
SEPTIC
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ate