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ETApplication #1 S �i-6c3s"39 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 �f &OV -V Date: LIr Applicant Name: Address: Telephone: 601l _ "Z Lo -- 10 r - Property Owner: PhoneQJ S2 7 3� Lot Address: cknt� 3r, Name of Park: ,�c,t.- C�°©5 S 1n atm Lot Number: I-q1-�� Parcel ti`s PIN: I rl LOS9-t.R4--, SW DW TW (Sizex) # Bedrooms_ Year 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 Signature of owner or�authorized age DO NOT SIGN BELOW — FOR OFFICE USE ONLY Authorization of Existing System nature of Envir mental Health Specialist -a,-i 5 `- Date SEPTIC 4/08