ETApplication #
Harnett County Central Permitting
PO Box 65 Ldlington, NC 27546
910-893-7525 Fax 910-893-2793
www harnett org/permits
Applicant Name
Address 4 d'
Application for Existing Septic Tank in a Mobile Home Park
Telephone
Property Owner
Lot Address '2- o.-c- k- a,/ a VA `
7" { n es Lot Number
Name of Par
~ik n
07 -12,z6a00
~ 3 PIN L723--
Parcel
' SW DW TW (Size _x.. ~ # Bedrooms _ YearfiJ1_
L.
Power Company ~ e- _(For Progress Energy we need the premise number)
S ecific Directions to Job from L 11 ton r ~
s-mac- -e _ 'a -A Gk aV')
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 matron is correct
r
Signature of owner or authonzed agent
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
Sign Lure bf-Snviron Health Specialist Date
SEPTiC 4 /;1-- 11:L3 0
4/08