DOCUMENTS Application # ► 1 sc4a2s II
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: 1)5'a r.++esrmcti;s Date: 9-u- t1
Address: 3 83 NS Ht Al. L1, I-4-Z AJ(-TON AJC -lZ rqV
Telephone: y io _ 3o3- 19 In
Property Owner: o5 =r.+JcSrwt S Phone: 9lo. 3o3 . 1941
Lot Address: (, L.taArr D2.. i r LLz taczronJ . MC 27Sy ✓o
Name of Park: -rke Lot Number:
Parcel: 130 Ltzo CO tic 0 '3 PIN: Dia 3o - S7 - 9egq
✓W_DW _TW (Size 112 x I: 4 ) # Bedrooms 3 Year 2.0 11
Power Company: (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillinciton:
TAKE +-121 N. Towneo5 SV7N Fat) ;Ht PARK
l.Jt LL Air o,. THE 12:1.4 ETT APPRox1 rnATCL" q
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: 77
DO NOT SIGN BELOW- FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environmental Health Specialist Date
SEPTIC
4/08