DOCUMENTS Application # fl SL 3(I- -)
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: r)SN rN✓es-nw Ts Date: 9-'-t- ri
Address: 3\543 ins Hzt N. LZ k2N caoA/ n3 L Z�e t-14
Telephone: 9 io _ So3- w 4'7
Property Owner: 04LA 2NN=sTmEN'7-S Phone: 9 ro. 303 . I9tri
Lot Address: 31 LLAArr DQ, s t r u= r3 c r ro fr.) . Me 7-75-442
Name of Park: —rkE Lot Number:
Parcel: 130 Lao OOLIS o3 PIN: Do - 5-7 - 9egg
✓W DW TW (Size I ( x 4 L ) # Bedrooms 3 Year zo f l
Power Company: (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
AKE kU N. Towet05 SV}NFORD T n; PARK
w2 Li- Re oN THE RZT.G I-IT APPRox:I. nikA-TELY 4 t+..jct.
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 it false information is provided on this
application.
You signature below certifies that all above information is correct.or
Signature of owner or authorized agent: . 777 -1G/';
DO NOT SIGN BELOW- FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environmental Health Specialist Date
SEPTIC 4/08
HARNETT COUNTY CASH RECEIPTS
aea CUSTOMERType:
4Drarer: 1
Oper: 3BROCK
Date: 9/25/17 52 Receipt no: 95050
Year Number Amount
2817 59042347
91749 TECH 2
LILLINGTON, BP 27546HEALTH FEES
134 4180.813
EXT TANK
DSU INVESTMENTS
fender detail
CK CHECK PAYNEN 1333 $1013.08
Total tendered $100.00
Total payment
Trans date: 9/25/17 Tie: 0:22:80
** THANK YOU FOR YOUR PAYMENT **