ETHTE# 1q `SS -34242
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ' �5 �-f� 33�,�s�;�! i f4"IWOk AW OOL PHONE # 't 2 — ?/ ° 17 -76
I
ADDRESS
NAME OF MOBILE HOME PARK OR S/D C o-4 S'
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 55cj !/ — ✓ tls
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 BE5' FROM 1 OF •
AUTHORIZATION OF EXISTING SYSTEM
Sign4e4re of Environmintaf Health Specialist Date