ETHTE #: 14 -5 -33743
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Cheryl Lowe Phone #: 578 -2783
Address: 99 Dockery Ln Cameron NC 28326
Name of Mobile Home Park or S /D:
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and #): West Rd
Purpose of Inspection: Man Home (14'x48')
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
6A.11 1 N W I I IS -
AUTHORIZATION OF EXISTING SYSTEM
Sol
Signature oflnvironinen ealth Specialist ° ® Date