DOCUMENTS I Ia(# Application # 1g5hn(-I33a-3
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnettorg/permits
Application for Existing Septic Tank In a Mobile Home Park
Applicant Name: CN C7— M14PLi (urAAFan i.LC Date: /
Address: '¢ 6 0 5 C7(eau rlF r/ '�r s - e 3 01, > yrfh 8,1(4 Sc
Telephone: L%/ 0) 5 2-4 — D J 3 .� L(
Property Owner: CH-Ej - M Ff P 1 //isy ion.LYFione: go 4 - 5 3 7 — 2-9_5
Lot Address: ( 5 — /4ho
ur1Jre . f
Name of Park: O/c/ /-/ u<l /re c/ - Lot Number: /5
Parcel: PIN:
/SW DW TW (Size x ) # Bedrooms 3 Year / 797
Power Company: (For Progress Energy we need the premise number.)
Specific Directions to Job/ w a /from Lillinaton: / /
Ta I`p vl rF .- �7 "5 71- /n /e°aa 1"rsni o
0/i /-/e/n c/l rec!/ Leo7' .
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 information is correct.
Signature of owner or authorized agent: ata i' w " -
DO NOT SIGN BELOW- FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environmental Health Specialist Date
SEPTIC 4/08
HARNETT COUNTY CASH RECEIPTS
a** CUSTOMER RECEIPT a**
Oper: JBROCK Type: CP Drawer: 1
Date: 4/26/16 52 Receipt no: 332855
Year Number Amount
2018 58043883
152 OLD HUNDRED LOOP
LILLINGTON, NC 27546
64 6P — ENV HEALTH FEES
8180.00
EXT TANK
AHA MUNROE
Tender detail
CP CREDIT CARD $180.08
Total tendered 1100.00
Total payment $108.08
Trans date: 4/26/18 Time: 15:50:28
** THANK YOU FUR YOUR PAYMENT **