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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LH.LINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME rfi.d DTs/I Ikoc-E PHONE # _7/s -.rr7 - 3e7 y
ADDRESS ~!!P 02~- 5 r V. iu . C . ,275 z ~
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) H-0 dc~t-
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ~ 1*3
40
THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or
(2) the system should fail or malfunction, and/or
(3) the owner or tenant of the property changes, and/or
(4) after six months
.rs Se'Ya✓-fir-~, i-- , -r y 1-rY- 1- r--, Yr s a~r rI~z- -s- ,,,7 > r " v.,~,, - " -ritr, a r
AUTHORIZATION OF EXISTING SYSTEM
1
4..- q
Z-l0 -O
ature of Environmental Health Specialist Date