ETApplicant Name:
Address: I 1 1,
Application#
- -SLO—
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www.harnett.org/permits
c Tank in a Mobile Home Park
Telephone:'�)W—
Property Owner:
Lot Address: 3
Name of Park:
: (Allo- <4q-.1-2-95 --7
rA (' - -7—� lCi ( I
-ot Number:
Parcel: PIN:
SWL��D TW (Size -2S x
---a2j # Bedrooms
Power Company; (For Progress Energy we need the premise number.)
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 inform tio, is C ect.
Signature of owner or authorized agent: 7:*7
DO NOT SIGN BELOW — FOR OFFICE USE ONLY
Authorization of Existing System
SigAture of i4tWironme6tal Health Specialist Date
SEPTIC
4/08