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ETM t-E- l~ Application # G f d Harnett County Central Permitting PO Box 65 Liilington, 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: Dater V3cIIV 210 i Address: , . [3c> x l 131-1 .11cx Al z-3~ Telephone: ~t C7 - ~t irS" - Property Owner: Wk Ev's fL ,\,t' ,tA~~~ hone:` 1r4.-~ ~Sa©r3<~~U Lot Address: H-L L-of 'r r ~~5 P-,A e+ ~C Z~SCa.S' Name of Park:. F-G.tk e s t...cr x^d~" IP Lot Number: _ Z 7 Parcel: PIN: SSW DW TW {Size ILA x 1 # Bedrooms Year `17 Power Company: PVC e, y'CS,S (For Progress Energy we need the premise number.) Sopcifig Dirertigns to &b from Lillington: ~t1 G Z.'7 g l y&o L-o E' -Cc. v i M °t 1, 'P tA 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 info ation is correct. Signature of owner or authorized agent: NOT SIGN BELOW - FOR OFFICE USE ONLY Signature of Environmental ap Specialist ate ~.N uthorization of Existing System ~S