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HTE# 45-- 335-5-1 HARNETT COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH 307'CORNELIUS HARNETT BOULEVARD' LILLINGTON, NC 27546 EXISTING SEPTIC SYSTEM INSPECTION NAME PHONE #1 ADDRESS ZQ tu".ij(ou P- —A)-(f,.- -° f NAME OF MOBILE HOME PARK OR SID NAME OF OWNER (IFDIF'FERENT)l ADDRESS OF OWNER, (IFDIFFEREN1) 2"7 PROPERTY LOCATION: STATE ROAD NAME AND # -{ Z, j 1 PURPOSE, OF �� X t f" ��+dy�r� Tt Io n as Depl Il� Ti r1. Y ka��,il ,an I[r Qpar tc a "e�tr�r AT sr t l s s � ski tc� � i �s" s raspc�n�ib�� rlrialfu�ct ©, h�o�rner r x =, ` y`y s�;,�; a a ��' r. �nasa'ry(����z � �. a , 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 BUILDING MUST, BEY FROM ANY PART 0;:, .grPT1c.. .qvGrFU SiWture of Environmental Health Specialist