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ETt Application # 1 t~ ` Harnett County Central Permitting PO Box 65 Ullington, 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: C ~G 4, 51.E eeOa vOc Date: Address: 'P, d t l 3 L-1; V S 2-!&31q q Telephone: --t 1 0 c5t Ei, Q //l. N- lS Property Owner: Fir n -xkc W xae- vs A-L1 t,nL \.k)' 111"Q kns Phone: I 8'4 10 - 'I t . S-1-1 Lot Address: )j25-~' .rIJL.- SrbS- Name of Park: V--eA,31 e'5, LNA t %A ~ M Lot Number: Parcel: V9- 74-1 O© S1 PIN: X SW DW TW (Size 0-4 x '10 } # Bedrooms 3 Year G-(o Power Company' Io!S~+ref-> F-vt 12 L"4^ (For Progress Energy we need the premise number.) 1i2_lc~ OSSS, e V, e--k t 5 e Specific Directions to Job from Lillinaton: j l -4- i "Ito t< et~l e 5 a tid i vt M IV Z"7 5O"t 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 infor at' n is corr t. Signature of owner or authorized agent: DO NOT SIGN BELOW FOR OFFICE USE ONLY Authorization of Existing System h Specialist Signature of Environmentah (t ate a1 ~~~c S