ETHTE 12-5-29424
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS H.ARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Lawrence Curtis Phone 919-708-2316
Address: PO Box 1133 Broadway NC 22505
Name of Mobile Home Park or SID:
Name of Owner (if different): Joyce Keene
Address of Owner (if different): 6225 Old US421 Lillington NC 27546
Property Location (State Road name and Old US 421
Purpose of Inspection: Den Addition (14`x25')
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If the system should malfunction, the owner is responsible for any
necessary repairs.
BUILDING UST ' FROM ANY PART F SEPTIC SYSTEM
NOT DRIVE A N SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
1
Signature