ETApplication #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546 OZ1j��{l0
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
A lication for Existing Septic Tank in a Mobile Home Park SCANNED
I AUG 3 1
Applicant Name: 0 A n t°u k�w-+ Date: 2017
Address: 9a. 6oX 111
Telephone:
Property Owner: Phone:
Lot Address: �AA
Name of Park: N� 11` kU (Nb Lot Number:
Parcel: 12DSSo oqw PIN:OW 9-KI9,CUD
V SW DW TW (Size Jy x__70 ) # Bedrooms 2 ' Year 4915
Power Company: (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillin icLon:
I 30 a'c'v i n tY►cNei d
6�1
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 i rre
Signature of owner or authorized agent:
PO NOT SIGN BELOW - FOR OFFICE USE ONLY
\ Authorization of Existing System
Signature of Environmental H th Specialist I D to
SEPTIC
4/08
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