ETApplication # /6 J-Po 2 / /0J,
Harnett County Central Permitting
PO Box 65 Ldhngton, NC 27546
910-893-7525 Fax 910-893-2793
www hamett org/permits
Applicant Name
- / r2
/
Address -76 L S Y?
Telephone G- f -
Property Owner
2
hone
Lot Address a ` '1MAP
Name of Park z Lot Number
Parcel 13 O 24 i!~ PIN Ob 3O- 7 " 771. 700
-XSW DW TW (Size l x If } # Bedrooms -2- Year_4~
Power Company (For Progress Energy we need the premise number)
Seecific Directions to Job from Ldlmaton
7` e ;'t ")'-)e C//
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 informate correct
Signature of owner or authorized agent
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
ignature of Enviro en a eaith Specialist ate
SEPTIC
0-
Application for Existing Septic Tank In a Mobile Home Park
4/08