ETApplication # 1 -756Qg6 V �
Harnett County Central Permitting C
PO Box 65 Lillington, NC 27546 lh�Qv':
910-893-7525 Fax 910-893-2793 V /�I
www.harnett.org/permits J -3J
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name:
Address:
Telephone
Property Owner: N < N h a li SO" Phone: -1 / h - J -] 4
Lot Address: / L t t
Name of Park: ^ h C -Loi u be r: 0-30
Parcel: 0-71 U 16 6�P� OC -e PIN:1S 19 ODU
SW ADW _TW (Size a,_�_x_jEfLl # Bedrooms 3 Year 1 <qa 9
Power Company: DU k- e— (For Progress Energy we need the premise number.)
S ecific Directions to Job from Lillin ton: Q
C7 Vr Yi �'1 D ,J'►1 l�
1 " kellv At, y y
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 . r atio orrect.
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
o- 1/
SigKature of Environm al ealth Specialist Date
SEPTIC
4/08