ETApplication # T) 15000qS7
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: Awrk AIA4 /kword 'sr, Date: 3-/Y-.20/7
Address:
Telephone
Property Owner: 3-/P// h6wora( TryS t Phone: �(g '(.27 /f(71/Lot Address ga $ leo/%rs �owd
Name of Park: S00%Cs,cde, &//P ff, Lot Number: y9
Parc/el: OGyS
R()Doo3 PIN: --O—&/ y5 - 7S' 2$/0.000
W DW _TW {Size fy�xao�, # Bedrooms A_ Yearfg5
1
Power Company_ Dobe/} rr5s rC„th�,� Y t35;1N or Progress Energy we need the premise number.)
Specfic Directions to Job from Lillington:
Ta ke, Y o i S is P' -let) Gmve A141 4&gl tori /elf ivrn le4e D,1
waA iCppd� f „rn /l f E nA Qe /1".1 S .Po 4 d Go t Y9 's 017 f�G
66,21% 6ASf C&j2 o!C ,11&5ecr4'o,1 04 WAJS14;9" Ibad a -.f xo/%.S xoadl
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 information is correct.
Signature of owner or authorized agent:i l
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
—� 1(1" 05�A� 3 -
of Environmental Health Specialist Date
SEPTIC