ETApplication # 57M 2 7 7 ~ .
Harnett County Central Permitting
PO Box 65 Ldiington, NC 27546
910-893-7525 Fax 910-893-2793
www harnett org/permits
Applicatlo for Exlsting eptic Tank In a Mobile Home Park
Applicant Name a
Address 2- Telephone
Property Owner
Lot Address _
Name of P
Lot Number
Parcel U ~ S U PIN
ZSW_DW___:TW (Size l x # Bedrooms 2 - Yea
Power Company (For Progress Energy we need the premise number)
DlreCtionS to Job from Lillm ton
S ecfic
7 7
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
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Author abon of Existing System
"4
nature of Environ al 44ealth Specialist Date
SEPTIC
7Z4
Oros