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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 'jy.ZiL,~, j -
PHONE # aid-SS7-//y
ADDRESS _ 15'0 =S4:C=~~Z J k1 Al
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NAME OF MOBILE HOME PARK OR S/D d
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # fiG/y/y
7~ 124w~s
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THIS INSPECTION IS VOID IF: * SrNz A&A- ge)r/ rb.AA)G
(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
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AUTHORIZATION OF EXISTING SYSTEM
1-13-m
ature of Environmental Health Specialist Date