ETApplication#
Harnett County Central Permitting
PO Box 65 Lillington, NC 27548
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: t -j4;" xNJesTw%ev %s Date: q --Lt- t-1
Address: 3 %$3 v&s yzr N. +-z L�=OV wTOA/ A; C, z-1 s"u tr
Telephone: 'J I0 - 303- ICa 4-7
Property Owner: r --SLA vv%ire, -rs Phone: 9 10. *3 o3 - Ic, vi
Lot Address: foo kAART DP-, t �s LLz IJGTA)�/ . MC, Z7 s, q (0
Name of Park: -rkr Ho -%v PLALE Lot Number:
Parcel: 13o (uezc m4so3 PIN: D630 - 57-9$G4
✓W DW TW (Size -! to x lk 4 1 # Bedrooms 3 Year 2-0 11
Power Company: (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillinaton:
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wSLL. n' oA; i Hf IL'LG FIT APPRox1 rt%AE—npt-i' 4 em, les.
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 an this
application.
You signature below certifies that all above information is correct.
Signature of owner or authorized agent: — %~
0 NOT SIGN BELOW - FOR OFFICE USE ONLY
uthorization of Existing System
Signature of EnvironmentaltIAMth Specialist bate
SEPTIC 4/08
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