ETApplication #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harneft.org/permits
0044, Oq(p
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: Ki� Lrlrnci LMSe Lt -C. Date:2-(o-Low
Address: TO. E0i- 2533, GhriSt gr sy vf�a Vp, otog
Telephone: 540- 35 -1 -
Property Owner: t-3` Ua nd lecL-.e, 1-k c-
:54y-5S7-5y-r(p
Lot Address: ,�1 1Fe59 y Sree i ffI 12YD
V
Name of Park: /-\r6evwr-) Gree L Lot Number:
Parcel: QIO5IS 03(e'") PIN:015)5- 5-0- 4Lo5v. ooc>
VSW DW _TW (Size -)A_x L&) # Bedrooms 3 Year ZOIg
Power Company: bUtih P -i W r E1 -1C (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillinoton:
2fo fz Citi. -furry rl'ahi
Dnto
Duerh'(1 M
'i(rn rtq
i hn f &JIii 5477 -F
IIA rn LL- 4 t? 1iy (QYOkn
b)
(fVykr-- r7
'rev_ Y- lYi+jP)
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
Signature of owner or authorized
SEPTIC
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environmen ealth Specialist Date
a.rl-ls
S
4/08
A