ETApplication # SO 6,0'eHarnett County Central Permitting
PO Box 6 Lillington, NC 27546
910-893-7525 Pax 910-893-2793
www.harnett.org/permits
Application for Existing Septic Tank In a Mobile Fiume Park
Applicant Name:
Address: £I "t
Telephone: I L
Property Owner: ULe
Lot Address:
dame of Park: Lot Number: ,
Parcel; l* t PIN:
SW ~aVil TNI (Size x ) Bedrooms Year
For Progress Energy we deed the premise number.)
Power Company:
"-r--~-
There Is $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:.
SEPTIC
C
4108
4