ETApplication # IV') ELy- q a 3S
Harnett County Central Permitting
PO Box 65 Lillington, INC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: u ru�esTw r --%j s Date: ci - -,- t - tl
Address: _ 3% jg3 v.s Hzr N &Ton/ A+<- z" su f,
Telephone: 5 io 303. 1c, t„ -i
Property Owner: asp rN✓c`sTma-A1T5 Phone: `1 '0• '301 � 1563
Lot Address: S i..LAAtZT PQ. N ^� -7 5'
Name of Park: -rhr= r V. z C ` Lot Number:
Parcel:_ 130 tszo e0'4r o 1 PIN: D43O 5-7-91S54
✓W DW _TW (Size 16 x 4 L j # Bedrooms _3 Year zo 0
Power Company_
Specific Directions to Job from Lillington:
Progress Energy we need the premise number.)
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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 Environme
SEPTIC
Specialist
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