ET RApplication # Harnett County Central Permitting
0 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 _ r,r.~,~ot. T,-a l^cr l tarot
Date
Address ' 7 k2jj~
Telephone X19 - 4 ~4 - a-, ~a I
Property Owner Phone
Lot Address g e
Name of Park A M P Lot Number
Parcel
PIN dCn~~~
_-)~3-SW DW TW (Size X `7(0 } # Bedrooms`
Power Company
j (For Progress Energy we n
V
Specific Directions to Job from Ldhngton
-_a !t ? h ~uvA to t7 Uc~ ~l , ~v„r i e, f L Crn nn
=--L5 5-0 o d o
earl'
d the premise number)
There is a $100 00 charge for this service This certification is subjec 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
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
of Exist!qg System
L-!7:ure of Environmental Health Specialist
SEPTIC
4/08
-1 Poe 41 732I