ETApplication # __ I rl.rno
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harneti.org/permits
Application for Existing Septic Tank In a Mobile Home Park
Applicant Name:
Address: 3 2- 61 mc -n c i I i rR i I I 6ZA
Telephone: ° t0 - S of :a - E0145
Property Owner: C�-
wa(YNC-
LMkrk
Phone:
Lot Address: _we-ja�
m«'t C-�
I af4�-Z , rJG
Name of Park: i Yl
% \
� i?- orlo 5
Lot Number: I Cp
Parcel:_ l':� tAc7,�[I-n(n
PIN:_ UpPI-)- L -5
I/"SW DW
TW (Size
x_fi0)
# Bedrooms _ Year l9a
Power Company:
rISE
(For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
- ,.)ies
oma; ckf-
LMkrk
t �1G(4T o�1
rn"
- R L!� tin Ami t e
L>s . f
Lit- i cjf'� WG^ IDr1\S G`�-'
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
Signature of owner or authorized
Signature of
SEPTIC
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
Specialist
31 t
Date
4M
--pl¢ect + Pro.E ,d S12 I11