ET- Application #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 l=ax 910-893-2793
www.harnett.org/permits
Application for Existing Septic Tank in a Mobile Home Park
Applicant Name: Nt<-L4"' APJ 7 C~~P ~E L/C- Date: d16
Address: 6 e w,~1~-, s s y Ar. 4v Nt `L-7 S-01
Telephone: 6 3
Property Owner: dal - L 4uj des k!.., Cpr,~ ar /,)C Phone: q I j(, 3 q 3 933
Lot Address: 1 e w^ v 0.., An C. 1:15-0
of Park: ere*11-. ,,N 00J 1(17 Lot Number: Lt 3
Parcel: PIN:
l SW DW TW (Size # BedroomsYear
Power Company: D, ie s 1744 (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillington:
4-o LQ,
b ei IC <--A i ti? - es • Flt 60 n - W0 r-9I VV X"a
.c.,tn ~ r ^d h.~,~.~ Lo .r.. 1 r2.~c„ v • ~ R',~ ar o-+ ~
1 P 1~p Gtr J ~L.lti e. 4-5 lrr-. 4 q ' rJ t~ ti 1' (5•r W
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 information is correct
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
gnature of Environmental Health Specialist Date
SEPTIC
4/08
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