ET RApplication # i Harnett County Central Permitting 0 271o
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 Par
Applicant Name: Date:
Address: -7 c ? fc .
Telephone:
Property Owner: Phone: 91-'-9, t
Lot Address: M'6p
Name of Park: l1 _ ~Lot Number:
Parcel' P PIN: 7 ~-J 420 XSW DW TW (Size x721 # Bedrooms- Year_L
Power Company' (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
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 informati correct.
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
c
Ignature of Envir nmental Health Specialist Date
SEPTIC
4/08