DOCUMENTS Application # 1P-1 . 3S
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.hamettorg/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: t>Su r.+✓EsTw.e.t s Date:
Address: 3183 tns Hzt N. LZ L�=,vo-To Al AJC "7--15-14
Telephone: 5 io - So3• lc 41
Property Owner: osLA r..):.1 srmENTs Phone: 910. 303 . lgv,
Lot Address: -7 5 L.t.AR,' PP.. r r LLr NFTSN . Nv -L-rs-4 L+
Name of Park: -rhe wo ..PLwcE Lot Number:
Parcel: 130 Leto CO4So '3 PIN: Dt,30 - n - `1egg
✓SW DW TW (Size Ile x 1. b ) # Bedrooms 3 Year toll
Power Company: (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillinciton:
"Tithe L4 N. To wpt OS SAN FctD THE PARK
ws LL y3E o.+ THE (LTG I-TT APPRoxl rvtATELV y .+.. I -t.
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: T
DO NOT SIGN BELOW- FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environmental Health Specialist Date
SEPTIC 4/08