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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME _Z&t Ce- .,,:I4/~.t s .Z'aG PHONE # _9/,O 7,56
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ADDRESS $o 2.otsc11 ),tx--t)je- 335
NAME OF MOBILE HOME PARK OR aS T
NAME OF OWNER (IFDIFFERENT) 15a( 02ps,.~
ADDRESS OF OWNER (IF DIFFERENT) _q6-0-4& -.7- rv .c Z~3 3S
PROPERTY LOCATION: STATE ROAD NAME AND !76 S O i s
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
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AUTHORIZATION OF EXISTING SYSTEM
01 ~ C-/ e (17Wi1 ea - q- 7
of Environmental Health Specialist Date
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