DOCUMENTS '1 [ S Application # 11-1.500 IF<i 5
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnettorg/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: GCJ-v/G C /70 e, Date: 7-// /7
Address: S'7/ , Ta' S o N Z i de ,5/eoa-c '<Act? al...a
Telephone: 9/ 9 q 99 - D /72--
Q/9 - e=ifP - 0/ ��
Property Owner: E../. ,Ylc e :P0 0/r Phone: ','O -l'73 - 94/.2-
Lot Address: 3 7 A "co
Name of Park: '2701e5 4211/1A Lot Number: 3 7
Parcel: PIN:
/SW DW TW (Size /`f x 70 ) # Bedrooms 3 Year /`'76
Power Company: e f A' C (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillinoton:
W +O.ccNSS J,hnsonv: l\e- tcAk:n3 Nikki ' 7 40 end -take Lt$ On
Nvsd47 -turn r i3hton G;1cnr&1- ''ed 3rd Lo* oc Lack
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: ean.e: C.e e
DO NOT SIGN BELOW- FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environmental Health Specialist Date
SEPTIC 4/08
1CA.r: sr.
{ SV021 02: STATE OF NORTH CAROLINA itelna10i. 'w
MYR,BI May NBRI CERTIFICATE,OF TITLE
TITLE NUMBER ORD88NEIOHT 'UQENSEEEE TITLE ISSUE DATE PREY TITLE F
[774290992298043 „ 08/27/1999 000001310350290
VEHICLE IDENTIFICATION NUMBER YEMIMOPEL MAKE BQOY STYLE E .
MINC84795 1990 MANS %-MH
.. ifAILMOM]DR4M�'. E..
WALTER MARTIN POOLE ill
571 JASON LN
BROADWAY NC 27505-9071
FI
owNERISIWALTER MARTIN POOLE I
NAME ANDEUNICE CAMPBELL POOLE
ADDRESS 138 GILCREST RD FI
CAMERON NC 28326-9449
E
IXINO LIENHOLDEN. HA TE
ElmCtRwYbnn YM1MSB
dilator NW&W I I
of North Canalis hereby cn1J that an appau-
IllRonfor acertNRYeYUde Nthe bomb dsRPad I
nhkk Madam Sled pursuant to the OmlerY NF F I
tuts of NYY.Carolina and the Division of Mohr
YehlekaYsalted that MA applicant lathe MIENI
owner.OOMNItwos.nitka DIvMMatlbarVM �.
Ides rant vehicle Is nWYt b Ole Wm If my, 1
SRO RELEASED BY -DATE hen*mnYYBha IA the dale YlaruanyMtta
SECOND LIENHOLDER. `vv'� DATE'. cant/Rata
AE WTINE&.Nr hand and weal of MR DINLIo.
the day and per wmYNEhhkcertificate ambit E.
R M aye.
�/- , t
COMMISSIONER OF MOTOWRVEHICLES A..,,
SNO RELEASED BY DATE a£
FIRST LIENHOLDER. DATE
s F'I
t Y-, liri t
1ST RELEASED ars 019910.91.9.1 BATE
ADDITIONAL LIENS', 63594345 F
47 T100473 aI
tiCansaulaESSIASIC ANY ALTERATIONS OR ERASURES VOID TITLE aRsn 0 `,
Application#Y1-5 W y ( g..5
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910-8937525 Fax 910-893-2793 www.harnett.org/permits
Application for Manufactured Home Set-Up Permit
(Please fill out each part completely)
Part I-Owner Information:
Home Owner Information (To be completed by owner of the manufactured home)
Name: -t a (4 T].�`e Address: Si ( Squy\ Loire.
�x
City:$YO6tLD4N"' Slate: lyC_ Zipl S36 Daytime Phone: ( )
Landowner Information (To be completed by landowner, if different than above)
Name:-Ft C11, C .C, f't\'e Address:
City: State: Zip: Daytime Phone: ( )
Part II-Contractor Information(To be completed by Contractors or Homeowner, if applicable.
Name.addrem. 8 phone m st match information on license)
A. Set-Up Contractor Company Name:1o.t4 e n C_ hA t{��yi k../0.)e.,-.S
Phone:etR ZZ5-3toOD Address:32) 5 �L t`l.L-t t ti
City: Sa-l ....rd State: kDC zip: ;1 S2) "1
State Lic# 3 LAD-0 Email:
B. ElectricalriContractornt7 '� (Coompan Name: �e.n C �� ✓ \ r-�
PhonB!0- \ \1"-]h Address: CC\ lP "lpv-
Clty: EA7i, State: IS)C . Zip:
State Lic#c. (Q€mail._LiLF_
C. Mechanical Contractor Company NameTt �y.��
Phone:321:11_01___
�q`�IOAddress: }-t Lt ikC 1)cy _Cji --�
City: 1w__A7(� State: N( C Zip: (37-R 5 `'f11
State Lic# rQ a, t 5 Email:
D. Plumbing Contractor Company Name: \-2.cbvsich C_C M1-\ i.AOU4Q.)r5
Phone:CLf�--in -3(0C)O Address: 33357)C .Jt .L � `J
City:c7_l1Ff.vCt State: tO C zip 1 '33
State Lic# C)T V Email:
Part Ill-Manufactured Home InformationI1
nS
Model Year: \ 0 Size: k
\ `*X 1 D Complete& follow zoning criteria sheet
Park Name: t J�-`ei nn, '{-- p /
Lot Number: ( 3 p L9 r 1 c. \ntr S ),---
I
^I hereby cenify that I have the authority to apply for this permit. that the application is correct including the contractor
iniormati d have obt ' their permission to purchase those permits on their behalf, and that the construction or
installa'on will onfor to the livable manufactured home set-up requirements. and the Harnett County Zoning
Ordina ce. I un rsta d that if an it m is i r ect or false information has been provided that this permit could be
revoke2 -_
Q � ---C-4. pl
Signa 1e of Home: ner or Agent Date !
'Effective July 7.2004, a County Tax Department Moving Permit must be provided before a Set Up Permit will be issued. It is
purchased from the fax office o/the county that the home is moved from. If the home is from a dealer, we need proof of year on the
Form 500 and if available. the serial number.
List of inspections and Egress requirements available upon request. Progress Energy customers must provide Premise Number.
SETUP
04/11
H m 00 O -a to O
m a 3 c”. 0 3. . � ! y O �ECAFATa..
LT"
_ J r ° m m ctJP L: flujil
_ o m
m z o 0 C
3
0 0go pya a - D r = - D
O O NO yS ? -. Qq O _
32 V m •
N m '
m F . m 3 ...— --1.
o O
3 40 •w � 1J a � •
O a n m m n •■ 3
m o'a J
0 3 m m O
Z m � y C
d $ o
O
Ilk
N m co
i
m a a
_a a
m
C V
on
0 C) M
(n \\ r \U
0, �1 J
• i
M
0
��
at m
0 xi
C m 3
H 3 3
Ea
,J , N
r-ii ON Mil
/