ETApplication # 1<MWv( 3a 3
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: \�Iv-)C1 U Cl SP , LSC Date: 2—U ZUI o
Address: -P.C. bo 1 2b33 UA ND(z)6
Telephone: rj40 - 35'1- 34-1 (P
Property Owner: NC �anc--A UC'C- t l_LI` Phone: 540 3 11'-14-71P
Lot Address: 1VD LA✓ n 44✓po-1- xOiq r vo I n v o
Name of Park: t\nAevC(,ce1� J
�r�
Lot Number:
Parcel: ell 0535 OW e3a L-P.oDb
J SW DW _TW (Size Ir�
rx� I # Bedrooms 3 Year 2CA!
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Power Company:Rw2r � r, ` (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillinoton:
2�soL01A (,\ (; A onty bvP�hl\ ['� �vrnY, �� onto Arch Sit +.
lei+ Dv -ft Nudln S C r r. b s.�Q
+i rn Ie(so l fCk i�rn I�%C 01�� �n✓l sir�i.
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
Nzasc Z �ti
Signature of Environmenta alth Specialist D to
o�- q- l 8
4/08