ET RHTE# 65-5 AS-T3 ~
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # Ji0 f r'p - 76r4
ADDRESS 17 Z 0 1.J 6~ °u~+cl v-L/ .5-i- lp y.J.J N C Z~333y
NAME OF MOBILE HOME PARK OR S/D !,),r
Cam-
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # 152 r1 6,5 o ~a s e,~ P4
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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r is 6* FROM'
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AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
i
Date
3