DOCUMENTS \D la
'1 { \� Application # \flabt4 aLo(4.5
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits SCANNED
Application for Existing Septic Tank in a Mobile Home Park OCT 3 1 z017
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Applicant Name: I-) I S S , C to I] Date: /0 - of 7 -1
Address: II0 7 G—r' P eft too- y ri J e,
Telephone: _33&& .- AL9/- `7357
Property Owner: PA,1., Sr nit efiv Phone: S36' '/9/- 7557
Lot Address: G31-4-e4.d€>ts br1JE 1} Nter11 c1/C -
Name of Park: 81&C,ie IQ C Qt-r MOP Lot Number: / I c, 7, Ji
Parcel: cC blD-1U (D&t4 PIN: (710-ata.Lo - o7SLD4 ,Gob
✓SW_DW TW (Size SI x 710 I) # Bedrooms 3 Year /6/d'7
Power Company: 14 Ke- PO WCC (For Progress E ergty"ire need the premise number.)
Specific Directions to Job from Lillington:
Co .sow N /4—COY a lD — ` aAit) e 1
b„-1-0 Hwy 55 . G-0 / a1r ;'t/e -1-ccr pn
w �{ t9-7) I c. 2/5 C h r t rcA ,QoacO , y1 o is �m !es oin Ie-f 1 , (4r(cad er'se motive.-)
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. ,pn��
Signature of owner or authorized agent: P..�; C L!/"
DO NOT SIGN BELOW- FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environmental Health Specialist Date
SEPTIC
4/08