ETApplication # 1 EbOq , �3 1
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793 ba (0) b
www.harneti.org/permits
Application for Existing Septic Tank in a Mobile Home Park o`(
Applicant Name: ft Land b tt '<A , L Lr— Date: 2' lv 20 1
Address: P.1'. bDb 2633 01� Iayrx f� JF} 2�TJP�
Telephone: 54 C- % - 50 -7(p
Property Owner: f - 3e- l-a-Yt U aso LSC' Phone: 514
Lot Address: Sd 1 Urn 'i ,-e4 Jt�Kin<, i GZr p
Name of Park: U (Sar') Ccee L Lot Number: nnn
Parcel: 0(05 35 DI(DOW PIN: 0514-yjc155.�4 i?Ov �Iv'
J SW _DW _TW (Size x tV (P ) # Bedrooms 3 Year 201 B
Power Company;,5ooh iR(\. r W, (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
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
!2gnature
uthorization of Existing System
Environmental He Specialist Date
4/08 s