ETApplication # I O `13) 3S
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits Conk#C��.
Application for Existing Septic Tank in a Mobile Home Park a b
Applicant Name:
Address:—f-10—ON 2533, Chr
Telephone: 5 u 0 3'5"7 - 3H 7 fo
t- &C
i
Property Owner: PC- enc( Lea fx- �L'c Phone: S40- 35 7-34-7to
Lot Address: `fes s. Brenda 6 rec a,
Name of Park:1ev5on Greeff Lot Number:
01 15 OB cn "1
DS1S - 50- q('3c). o6 v
SW DW _TW (Size 14 x -TO ) # Bedrooms �_ Year 190S
Power Company: 5w* Rkk eCY t; MC (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillinaton:
2-10 5ow1-K imrn r �W ontn QW011t( Rod -urn r� 4 bn+a Arch e SiYeet
Fyr n le �� arit7) ro h n 51(Rncte rbo r Cree n? itP iu ✓n lei f on } d
S. �Jrenvia 5�ree.f.
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 fa41nforms provided on this
application.
You signature below certifies that all above inf r tion is
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environme?1 Health Specialist D e
SEPTIC
4/08