ETApplication #
Harnett County Central Permitting
PO Box 65 L.illington, NC 27546
910-893-7525 Pax 910-893-2793
www.harnett.org/permits
Application for Existing Septic Tank in a Mobile Horne Park
Applicant Name: fillen } r ' Date. 49 it
Address.'
Telephone: I . - < ?
Property Owner. ,....:,.Zee, Phone. -'f
Lot Address. <
Name of Parr: " ➢t r ' Lot Number.
Parcel:," PIN:
W _DW TW {Size . _ x # Bedrooms Year
Power Company " + 1 (Far Progress Energy we need the premise number.)
S ecific Directions to J from Lillin on
There is a $100.00 charge for this service. This certification is subject to revocation it the
Intended use of the septic system changes, or If false information i provided on this
application.
You signature below certifies that all above information is correct.
Signature of owner or authorized agent.
DO NOT SINN BELOW - FOR OFFICE USE ONLY
A thorizati of Existing System
ignature of Environmental Health Specialist Date
SEPTIC
4108