ETAppllcation 4 ( S
Hantett Count
PO Box 65 L NI Central C 2754
910.893-7525 Faux 810.893-2793
w�vw. hamett. or9/permits
Applicetlon for Existing Septic Tank In a Moblle Home park
PPllcant Name: tit i)w � I
Address: cmc Dom., __ _ - not..
Telephone:
Property Owner:
Lot Address:
;Name of Park:
Parcel:{ � i r,'t` —` Lot Number:
'SW ✓Dyy``sc�Ls�`_-,-- PIN: _
(Size2�. Z
Power Company; _x C- # Bedrooms Y Year
--- -(For Progress Energy we need the premise number.)
Specific Dom; ,,ts t from Lillino+��•
There is s $e of
charge for this service This certification is subject to nvocafion if the
0plI dad use of the sept)<: system changes, or it falee Information Is
appllcatlon.
provldsd on this
You signature below certifies that all above information is correct.
Slignature of owner or authorized agent:
NOT SKIN BELOW _ FOa OFFICE USE ONLY
Authorzation of Existing system
SEPTIC
i
4/08
a