ETApplication #
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: , -rel V N Date:
Address: 24717 r / t/ 71f !i 9 bd v e .esa.-v 41• e, .zy3 z-a
Telephone: S+yS 9' P'o ` a 61 E4 r.
Property Owner: `41,4/ Phone:
Lot Address: -_ _ 7- % %Za-Xg y< 4 r
Name of Park: v yz4y *«mac 6/6 Lot Number: ,b .Z
Parcel: PIN:
I'/SW DW TW (Size l4' x rd) # Bedrooms _ r Year 1/fY,
Power Company: 6,� e� ry t°i .- (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
ZL±v/ z 7 -%--�eV1' z..-
I L�/ 7�G G .7 /,,- /-/
1&10-6 / i It ®Od%dl
Lu2 �„ C O-
r
There Is a $100.00 • • certification subject to revocation
intended use of the septic system changes, or If false information Is provided on th
application.
You signature below certifies that all above information is c rrect.
Signature of owner or authorized agent:
Sig
SEPTIC
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
Specialist
D to
4/08