ETApplication #_ 115-CC'412 4 L
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.hamett.org/perm Its
Application for Existing Septic Tank in a Mobile dome Park
Applicant Name: SAMcfEL w7 Ta.r.✓�i2 Date: �r-c'
Address: %-990y 182 1'roS/rr, VA 23039
Telephone: Rr 4. 539. �Z-fL C sfur-net /a 3 T -X 4")
Property Owner. Sanyue / #7. -Turner Phone: Su!'- 539• '1245
Lot Address: l qoial� �e JG ar paeg = 12a'fS Air-- a.3- �,yg&i,, ,.UC�
Name of Park: _ EoB14s Le,,oL,hQ �1yiJ Lot Number:_Aq J
ran:ni. PIN:
_SW Y DW____TW (Size _fix rsg) #Bedrooms. 4 Year 211
Power Company: % �,�rgjf ?�036L �l19 (For Progress Energy we need the premise number.)
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:���
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
- S S S' )i
of environment aith Specialist Date
SEPTIC