DOCUMENTS `\1/4-0 `1 I — �-�t
C/ Application # ` b - ' 3�t d
O 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: . Date: r/ /6//p
Address: fo. /G / S7C 27670 /
Telephone: 97 7 6O. 5 - 4L957
Property Owner: .GV s-- ,f v'---- Phone: t/ 9 12 S - y 93— 7
Lot Address: 9 7 €'� .<✓ ,777.6:.4,_ / %• l/ - h e .2 7S a c
Name of Park: e+�/✓ `?7 &J a .f�,.r,. Lot Number: 9
Parcel: PIN:
✓SW DW TW (Size /t' x '7 G ) # Bedrooms_ Year / 9 9
Power Company: (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillinaton:
Iwo— 7.691- -1 zbist i3 J f ,L an— J'-aI.p 9 73 6+P .to
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 above informationn/ is correct.
Signature of owner or authorized agent: c17f' c.• 7C
DO NOT SIGN BELOW— FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environmental Health Specialist Date
SEPTIC 4/08
HARHETT COUNTY CASH RECEIPT;
*** CUSTOMER RECEIPT *0
Doer: JBROCK Type: CP Drawer: i
Date: 4/16/18 52 Receipt no: 323228
Year Number Amount
2818 58043808
73 B AND H LN
FUOUAY-VARINA NC 27526
84 BP - ENV HEALTH FEES
$100.00
EXT TANK
REARDON MANAGEMENT
Tender detail
CK CHECK PAYMEN 1332 $188.08
Total tendered $180.00
Total payment $180.08
Trans date: 4/16/18 Time: 10:30:55
wa THANK YOU FOR YOUR PAYMENT **