ETApplicant
Address:
Application #.) 60'4 QS -Q
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permfts
Application for Existing Septic Tank in a Mobile Home Park
Telephone: 5Y0 - 357 - j q%�
Property Own(
Lot Address:
Name of Park:
Parcel: (j..7)Slc� 4�S(0�Z PIN: 051S1 -5O- yb30.1000
,SW _DW _TW (Size q x_6L_) # Bedrooms _ 3 Year 1985
Power Company: E/-1 C (For Progress Energy we need the premise number.)
S BCe n cla.--
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 t correct
Signature of owner or authorized agent:
00 NOT SIGN BELOW — FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environmental aith Specialist Date
SEPTIC