DOCUMENTS Application # r7 4-a.34-ni
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/perm its
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: eeSu rkr/E s
Date: 4--Lt- I-i
Address: 3 1e as Hzt N- LZ r- 2NGTOA/ : ')L z' sol.
Telephone: 5 10 - So 3- 14 4,
Property Owner: o4v. yti‘ictrmENTS Phone: 9I0. 303 . 18G1
Lot Address: 4 S L-taAfl Q. t I r t-1= NN aro J . NJ( 5 ' U
Name of Park: -rr,e F-to% pLAcE Lot Number:
Parcel: 130 lszc Eo 4C o 3
PIN: Dt.3O - - Sig
isZBW_DW _TW (Size x I: . ) # Bedrooms 3 Year 2-0 11
Power Y
Com an (For Progress Energy we need the premise number.)
Company:
Specific Directions to Job from Lillington:
_
-YAKS 4Z-1 N. To wpRD$ 54.,,F'o#D ' T HG PAQ.K.
wTt-t- t3E oNA i HE (2-24 Fir APPROx2 ✓4ATEO' 4 fr,nlct.
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.oy �j'
Signature of owner or authorized agent: ' -'-'�-
DO NOT SIGN BELOW- FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environmental Health Specialist Date
4/08
SEPTIC
C
HARNETT COUNTY CASH RECEIPTS
Open: IB ROCKCUSTOMERTRECEIPT ***
Date: 9/25/17 52 ReceiptPn :D 95052
Year Number Amount
2017 50042349
91749 TECH 2
LLLINGTON, NC 27546
B4
BP - ENV HEALTH FEES
EXT TANK f180.B8
DO INVESTMENTS
Tender detail
CK CHECK PAYMEN 1333 $100.00
Total tendered $100.00
Total payment $100.00
Trans date: 9/25/17 Time: 0:24:13
as THANK YOU FOR YOUR PAYMENT as