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ETHTE# % HARNETT COUNTY HEALTH DEPARTMENT ENVJRONMENTAL'i HEALTH 307'CORNELIUS HARNETT BOULEVARD LILLINGTON, NC 27546 EXISTING SEPTIC SYSTEM INSPECTION NAME PHONE # fl' 5 ' ; ' S 36' ADDRESS 2 1 2701 NAME OF MOBILE HOME PARK OR S/D Mr-{ 2 5 NAME OF OWNER (IFDIFFEREN7) % ADDRESS OF OWNER (IFDIFFERENT) V, ; C PROPERTY LOCATION: STATE ROAD NAME AND # / LtO r tO PURPOSE O INSPECIIONn T i "a ' e t i � u fe b# die a t De r rria el t! , thy r (�o� `�h : �� z b n �i t��aarde a f, � �a." }''ti ati;g- „- „,".a'” }„ va `.Y.�tiy M�" w ��`e.„ yy� a'`ya )U alf to ct ©r t ou r► r is r s� nsib #o - 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 S uAture of Environmental 'Health Specialist Date