ETHTE# o?-5= 1906 3
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~yu~ y~5 v`- UTr~rr~ PHONE # _`lFi -s ~z-8368
ADDRESS P. a. 6" /,?z GIIl~vsJ N • C 77s"S z
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT) /ZyZ s;~~~ GZ1~ ~y,iv C
PROPERTY LOCATION: STATE ROAD NAME AND # /*7
The aforementioned site has been evaluated by, the Hamett County Health Department
Environmental Health Sectlorr At the time of lnspectlom, there appeared to be a septic
system serving thli site. If thli# system should: malfunction; the owner Is responsible W4
any, necessary repairs. 5
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 S' FROND ANY PART O SEPTIC SYSTEI&
DO NOT DRIVE OR PARK OIL SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
S
ature of Environmental Health Specialist
/Z-
Date