ETHTE# Jq -��- 33300
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ZA rs21 _ % 1� PHONE # 21 C'— -7977
ADDRESS� cx- c b LWA b rcJ>J Ju , C, % R `3
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # Pazo 140
Pir "OSE Q 'INSPE TIQN 2, 1
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nv[r nrneta e [ erot F [ ��:� t ap 1 safe,, to spt[��
,. 'e,.`� �ai�th"ax�, �"x�} s \� � ,�` ,•fir " 5'T�Je �t '�pu }�^ � '�"�' }"� .,�� s � �"�"�'�;; �N,��r, �,�� `� " a}, : �
systemenrrng t�tr�$r ft ter �sserr sio�r[� ralfurctortr the or�nar" rs; respgn[b� fob t
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
AUTHORIZATION OF EXISTING SYSTEM