ETApplication # l 57, - , Z l,?
Harnett County Central Permitting
PO Box 65 Llllington, NC 27546
910-893-7525 Fax 910-893-2793
www harnett org/permits
Application for Existing Septic Tank in a Mobile Home Park
SAS Date o -7 L
Applicant Name Cba,rle5 EC'i ar, ( 2011
Address aOO~; '~roo~cl•~o u (2 ~ ~ orc , Nc- a.-133a
Telephone lo
Property Owner C~ A"t w %it~~M-~ Ff~1L ?ou hone 15*(3-- 33x4!
Lot Address t00,ald bugle ]rive~.N ~C a`~ SO
Name of Park q-pt ` Lot Number 58
Parcel 63 PIN
SW DW TW (Size Co S x 19 ) # Bedrooms a Year (9 -1
Power Company R(-X1re55 finer (For Progress Energy we need the premise number)
Specific Directions to Job from Lillington WeS4ern
&o f-Iwy a-i wasc~c 4-4wv B7 ass b~ ~e Cep-{r~ h~ S
Lc~n~;~~te MototlR KOtAe fJot WJ( be On [P-4 Once yzoiq
~uCr\ k,. (N ConA-, nu-e cvli-rck ask (BOO tb Pale witl roe 51o one on
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 C 1 f it
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
Authorization of Existing System
Signature of Environ
Specialist
Me
SEPTIC 4/08
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