ETApplicationt� I (g �• ��.},1..�, u
Harnett County Centrat permry�f Ing u
PO Box 65 Lilhngton, NC 27546
910-893.7525 Fax 910-893 2793
www.harnatt.org/permks
Application for ExistingSe tic in a
Applicant Name: p Mobile Home Park
���
Address: t�G PJ __ ti, Tank _ _ r1are. - _ . ,
i elephone:
Rroperty Owner:
Lot Address:
Name of Park:
- , b
Parcel: �-�-�-�-� lot Number;
SW—DW pI����` -(--�- PIN: - - �Oi�
`TW (Size _^_x # B3drooms
Power Company��� G -3— Year_
cific Dictions -- --_._,(For Progress Energy we need the premise number.)
�r to hh r �m I 1pinot
There fs a $100.00 charge for this service. This certHlcatlon Is subject to re
intended use of the septic system changes, or N false Information Is vocation If the
aPPlication.
Provided on this
You signature below certifies that all above information Is correct.
Signature of owner or authorized agent:
00 NOT SIGN BELOW - FOR OFFICE USE ONLY
ALithorization of Existing System
Signature of Environrnertat tth Of
13
ate
SEPTIC