DOCUMENTS 3‘\a 1 ‘ 41r. Application # • c oaf
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 a
Applicant Name:
Gee 1• x Date:
Address:
TO Ti 9 9 1 nn NC as'331-1
Telephone: G 10 - 6011- 0-3
No_.rr?�z • <F,�.,r Phone: `� 19 &4'1� 9-3.�v
Property-Owner:�.£..�
Lot Address: �L
Z
Kcl'fN - r I .�
S Cc,,,,, • 5 Lot Number: 2— H
Name Park: Loa-e: L .4-____I-1.---• 9 2 3
Parcel:: 021 5 2 c,,, -7- PIN: 15
SW DW
1W (Size 14 x 65 ) # Bedrooms_Yearn_
Power Company (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillinaton: C
E o . .wyr I& - . 11" cLkf- orio V n44;19
j , C`v it- onio US- 92 15 n. TJrA, 1tit . .. \ 'SS,pas
Turn IeFi- c }o Cart d- Tr ; it ont .c: k S+. Mod°" c
itic
144 -Hi Sec.nnd Mob`.le home on +L rjkF. '
There is a $100.00 charge for this service. This certification is subject to revocation if the
intended use of the septic system changes, or if false information is provided on this
application.
You signature below certifies that all abov• rmation is corr
Signature of owner or authorized age
DO NOT SIGN BELOW —FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environmental Health Specialist
Da
y��
Ory 4/08
SEPTIC V
NARNETTRCOUNTY CASHTRECEIPTS
EP*** CUSTOMER RECEIPT ***
Oper: 3BROCK Type: CP Drawer: 1
Date: 3/12/18 52 Receipt no: 284427
Year Number Amount
2018 50043523
24 KEITH ST
DUNN, NC 28334
64 BP - ENV HEALTH FEES$tOB.BB
EXT TANK
GEORGE TALTON
Tender detail f1B0.BB
CA CASH PAYMENT $100.08
Total tendered $100.00
Total payment
Trans date: 3/12/18 Time: 11:36:01
** THANK YOU FOR YOUR PAYMENT **