ETHTE# 14 -5 - 3g04Z
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME k4 L,1 ,% U,J',-d PHONE # 4o-
ADDRESS 12Z 1�3 ,c-
NAME OF MOBILE HOME PARK OR S/D ,% &jo 1-a.�. s Pcv,44-
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # Ewl 1
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
BUIL
DING ANY PART , SEPTIC
1!
NOT DRIVE OR
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date