ETApplication if Harnett County Central Permitting
FEB X4 NO PO Box 65 Ullington, NC 27546
910-893-7525 Fax 910-893-2793 2~~1
www.hamett.org/permits T
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name:
Address: l5
4 do
Telephone: _ I9 L? $19 $
Property Owner: _ c 1
0 hnnu lairc~
Phone;
4199 919e
Lot Address:
,
Name of Park;
nes to
t.ot_Number:
}
Parcel: 9395 ? 6
di a I
PIN: °is?I-GO
-535 3, ooo
_W DW
TW (Size ~x~
# Bedrooms
Year
Power Company;
(For Progress Energy we need the premise number.j
agegff c Directions to Job from I-jllinaton:
There Is a $100.00 charge for this service. This certification Is subject to revocation If the
intended use of the septlc system changes, or If false information is provided on this
application.
You signature below certifies that all above info* ation is
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
thorization of Existing System
1gna re of Environmental Health Specialist ate