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SEPTIC Application # 1,25 7.--- r d Harnett County Central Permitting PO Box 65 Lillington, NC 27546 910 - 893 -7525 Fax 910 - 893 -2793 www.harnett. org/permits Application for Existing Septic Tank In a Mobile Home Park Applicant Name: 7 % q-(/_/9 � z'L!t7m %/ - 2 /o' . , Date;/O- c V-- Address: - 1 4/ i Zr L Z/ . CAI Telephone: V9^ 2/9" - 5c'2/ Property Owner: t2,.� Phone: 7/9 c7,- fl >$ Lot Address: l-- z 7 Z. Ai Name of Park: ` x'.19 TJ // 3715*° Lot Number: Parcel* /9 9 94 t' /7P? 4 S O PIN: SW DW _TW (Size x ) # Bedrooms .5 Year Is ? Power Company: - , „ �_r For Progress Energy we need the premise number.) Specific Directions to Job from Lillington:: c o v .z - 7 ,e, A.,nY - C d l 2 S - r-'` -c��, �'� y f / d , © e Is a 00arges his certiflcatl n is subject to revocation 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: e / ,29 z/ DO NOT SIGN BELOW - FOR OFFICE USE ONLY Authorization of Existing System Signature of Environmental Health Specialist Date SEPTIC ii 3 930 4/00 it---