DOCUMENTS f \v 11 Application # 1 O �� (-1(4 4 - 1
\ 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: May, dafr Date: I I S'} 2-- Lot%
Address: 5-6CAo/PiA� Lste'
Telephone: <1i) �e?-035/ 1
Property Owner:0TMir.�4,,��rr 3/ �t/)�- Phone: \' /7./ �Z2- `7
/77
Lot Address: ,2D (�re2iAdE LeyAl
Name of Park: 6,-/l4e- In 1-1r96c - Lot Number: 23
Parcy: PIN:
V SW DW TW (Size le t2x jt- ) # Bedrooms g Year 20 )8
Power Company: L� ‘r.,. -
.(SJ e ` 5cr------ (For Progress Energy we need the premise number.)
Specific Directions to Job from LiA.) on:6 _ , ^A ' q
Mi Las 4n0o4r'-4.) lr,EFr
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 agenIt
DO NOT SIGN BELOW- FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environmental Health Specialist Date
SEPTIC 4/08
•
HARNETT EOpe" CASK RECE9TG
axa COSTUMER RECEIPT ***
Goer: JBROCd Ty.ec CG Drawer: ,.
Date: 7/11/18 52 Receipt rn: 15419
Year Number Amount
2018 502444E1
50 CARRIAGE LA
ANGIER, NC 27501
B4 BA - dEA..TH EE¢5
4100.00
EXT TANK
MCGEE INVESTMENTS
gender detail
CR CHECK GAMMEN E481 x100.00
Total tendered $100.00
Total payment 4100.00
Trans date: 7/11i38 Time: 13:52:14
e+ THANK YOU FOR ?CAR oAfFer x4