ETApplication #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793
www. harnett. org/perm its
Application for Existing Septic Tank in a Mobile Name Park
Applicant Name: --~7611'1-1( C. t tG 1.C Date: ' 2-
quo cc, c t h t![ ( nl , s
Telephone: "t Z
Property Owner: l,'Al- J i r o 5 t
Phone: ( 1 ~ 5~"LJ _ & 3LK
Lot Address: i t o 'Tr-
Name of Park:S Lot Number: ' ?
Parcel: PIN:
SW DW TW (Size-141 x 70 } # Bedrooms -7- Year )f Power Company; (For Progress Energy we need the premise number.)
Specific Directions to Job from Lillin ton:
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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 ` rm n is Corr t.
Signature of owner or authorized agent:
DO NOT SIGN BELOW - FOR OFFICE USE ONLY
thorization of Existing System
6Z'cY~ zsi 1
Signature of Environmenta h Specialist / D to
SEPTIC
4/08
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