ETApplication # 1 Z
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Harnett County Central Permitting
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:
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c'}' Y i ~rl" Date 1 I Z-
Address: q'A
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Telephone: n ~ct)
Property Owner:
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Ek M. ( (]Q
Phone(9 ( Zo5)^ y .38 or
Lot Address:
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11,31,
qtG) (039_ 2y02._-hc~ ,
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Name of Park,
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1 lot Number: -74 yOLtn5
Parcel:
OPP
PIN:
,v""SW DW TW (Size N x "70)
# Bedrooms 3 Year M&
Power Company:
U l- L
(For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
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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 abovenn information is correct.
Signature of owner or authorized agent: ' Q,
SEPTIC
4/08