ETApplication #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910- 893 -7525 Fax 910 - 893 -2793
www.harnen.org/permits
Ication for Existing Septic Tank in a Mobile Home Park
Applicant 'Name:
Address:
Telephone:
d924 0-0417 A Phone:
Property Owner: ov, A
• •• < t
Name of Park"AD5- �J �P ome Lot�N`umber:
Par I: � / PIN:
�SW DW TW (Size 1'% x tO # Bedrooms Y
�) _.�._- ear
Power Compan (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
S f a P 5 ti �" t,. r- �, e i� f A a o bo c.. f
0o cr% n L 4-
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 cor ct.
Signature of owner or authorized agent: K-.A�Z U "
14.4 0 An
• • ,- •
Authorization of Existi g System
-0
viron
ature of Enmental Health Specialist Date
SE c
4108