ETHTE# do S-~`3 e1
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME %4,szo PHONE# dQ-~~D
ADDRESS J- ~ 5 L rq o p, gA V V, L" N ~ C- a~ 33
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) ~c~3C3~C G2C~o2Y
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # L.,.4o-n 9!ts~cvm L*,)
The aforementioned site has beerl evaluated by the Harnett County Health Department
Environmental Health Section. Afthe time of inspection, there appeared to be a septic
system serving this site. If this system should malfunction, the owner Is responsible for
any necessary repairs.
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
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
UTHORIZATION OF EXISTING SYSTEM
Signature of Environmental Hea ~ne.ri liet