ETApplication # 0?50 A W
Harnett County Central Permitting
PO Box 65 LiHington, NC 27546
Telephone Number 910-893-7525
Fax 910-893-2793
Application for Existing Septic System Inspection for a Mobile Home Park
Date: q'00
Applicant Name:
Address:
Telephone: _
Property Owner f• n.v r,Al~ rn IMP L LC, Phone: 9 1 0 - 93(o - 5 O 14Q
Lot Address: a 41 N K C C L E
Name of Park: rfffmg',t,s Lot Number. o
PaV PIN:
SW DW TW (Size 19 x_ 1.0 # Bedrooms 2_ Years J
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. nnn
Signature of owner or authorized agent ~ 6W J- C Oa.JAkfa
T SIGN BELOW - FOR OFFICE USE ONLY
of Existing System
Signature of Environmental Specialist to
5/07
11406~