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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAMES oLj,✓ PHONE 0/'0 'S 7- - gZS+G
ADDRESS fi? T,4.~,~~~ Tl~s~p d,3 S 3LI
NAME OF MOBILE HOME PARK OR S/D ~~Z~,~ Lam- 7
NAME OF OWNER (IFDIFFEREA7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ;5< /t307, 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
AUTHORIZATION OF EXISTING SYSTEM
S ature of Environmental Health Specialist Date
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