ETApplication #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.hamett.org/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name:t-t- �Zv--A �t-qc't Lam_ Date:�� -ZCI
Address: 0• 13( 2j 33 GV�riS�e„l�Sr,�ra 1tn, �)d7)[„C9
Telephone: GL+O - 3�D
54 --i (,o
Property Owner: t-�crot (_,eaSR
Lot Address:
N7
54O
"�- 34-7 (10
Name of Park: Andr--vL5r� (.:q I— N/lEi� Lot Number:
rJ3S r�
Parcel: n®D l 3O
PIN:_(i`�
SW _DW _TW (Seize x lPb ) # Bedrooms Year c9 -01S
Power Company: R�VQa/ (For Progress Energy we need the premise number.)
SSPecific Directions to Job from Lillinaton:
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On h
v ni
fi n r: �ti� o -Izy N-hSI-
0\Jt'V11; � 1 f
vol.- rt �
_ Ie=i:J ,awn
�e F t b n i z� fr�n 6Vr{k k br-.
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
Signature of
SEPTIC
DO NOT SIGN BELOW — FOR OFFICE USE ONLY
Authorization of Existing System
Specialist Date
4/08