ETHTE #: 13 -5 -31360
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Kathy Dailey Phone #: 910 - 986 -6876
Address: 195 Toodle Dr Cameron NC 28326
Name of Mobile Home Park or S /D:
Name of Owner (if different): William & Chong _Ray
Address of Owner (if different): 50 Auto Lane Cameron NC 28326
Property Location (State Road name and #): Bullard Rd
Purpose of Inspection: Bar
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If the 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 change, and/or
4. after six months
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AUTHORIZATION OF EXISTING SYSTEM
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Signature of Environmentale th Specialist
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