ETApplication #
Harnett County Central Permitting
PO Box 65 Lelitngton, NC 27546
910-893-7525 Fax 910-893-2793
www, hamett org/permits
Application for Existing Septic Tank In a Mobile Home Park
Applicant Name it L4e I WA. rue M (Plc Date 6 1-/1
Address ~IC7 Bill 116W IN 6u,) A) /~C Zfs33 (~A,~,A, G82 tj,~ R d
Telephone 7/0 g8qo2o8
Property Owner -SrrAmq B('HAaV Phone Lot Address ya sit Ply Dr~A)W Ik Z~33~
Name of Park hZa"1=_ Lot Number
Parcel (~2 J5 Z` 0 2 2 PIN
V/ SW DW TW (Size Ile x 001 # Bedrooms 3 Year 200
Power Company (For Progress Energy we need the premise number)
Specific Directions to Job from Ldlrnaton
X121 S -F0 19~ 7-,,e 1 -r<yy l xr 7~- 75-p or'
RAM ke. R r k-{- 7-akie- Z a k o ~A:v --Wise R8, l A1e6
T ,r L~ ,9A4D 6,11 Pl c<e IAA)f 4--,v ct0 V1 P6.0-- Coin1e-
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
r ature of Env nm n H alth Specialist Date
SEPTIC 6 li:~ Y 2 7
41111