ET RApplication
Harnett County Central Permitting
PO Box 6 Lillington, NC 27546 t
910-893-7525 Fax 916-893-2793
www.hamett.org/permits
Application for Existing Septic Tank in a Mobile Home Park
{
Applicant Name: Date. ~t
Address.}
27
t
Telephone:;;' Email:
Property owner: -Phone: 91 Lot Address:'
Name of Park; ;~-Lot Number:
Parcel: C,,0 cc>cl - PIN:_
_ZW „DW TW (Size _1 ~,,,,,,,,,,;x_2y # Bedrooms:_._J_ Year:
Power Company, {F'or Progress Energy wen d the premise number.)
Specific Directions to Job from Lillie ton:
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 infor ation is correct.
Signature of owner or authorized agent
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
r
ture of Environm ealth Specialist ate
E-Health For Mobile Home Park 1 of 1 06110