DOCUMENTS \ n? Application # ? SCJ Das
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnettorg/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name:
/Lc
D dig/1:S Date: / - r —/Y
Address: 2/7/ /3-/e TN M/CLs ,e(/ NC c.7S5z6
Telephone: 94/42-2P3--/ *-21)Sz j 7/ - — 2r/"-1//_�
Property Owner: /�TryhMZr? r-s Phone: 7/v s?i fz-2,>`�
Lot Address: e/2-6/EZ-4,9 51/x/,r/4sz£& /1/C.27S0
Name of Park: TE/2DiC l//uug Lot Number: "Y---6
Parcel: 0 OLD U U.D. DDIL4 PIN: Digs?: -Slo ,F2•o(
SW ITDW TW (Size lex/60 ) # Bedrooms 3 Year /773
Power Company: P(,/,C (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
.2/0 - //4 *7A.el / r t, e-n
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:
DO NOT SIGN BELOW- FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environmental Health Specialist Date
SEPTIC 4108
7
HARNETi COUNTY CASH RECEIPTS
aea CUSTOMER RECEIPT aaa
Date: IBROCK1d 52 Type: CG Drawer: 1
Receipt no: 205601
Year Number
2018 50043029 'lappet
61 THELMA ST
ANGIER� NC 27501
64 BP - ENV HEALTH FEES
EXT TANK $100.0B
HAROLD BOTTS
Tender detail
CK CHECK PAYMEN 8135 4188.88
Total tendered
Total payment 4180.00
4100.B0
Trans date: 1/&5/18 Time: 13:55:36
** THANK YOU FOR YOUR PAYMENT **