ETHTE# q1575`
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # 910 ® Y-Z Z,- G 3 z 9
ADDRESS` '26 ®�✓�.�T` �rz 2 z� ?a,, N .c. 2- Z-'�'�
NAME OF MOBILE HOME PARK OR S/D i gL &P s 3
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFEREN) 3 `- C z 75 v
PROPERTY LOCATION: STATE ROAD NAME AND #
PURPOSE (,I.INSPECTI ®N,; �-
fe foila 6111 erra i�aia by t ana �rY a Came
Ei�rnrrle� a r �r a s r s
n Ctrol� i h�� fasp c��� t t r�appoaro, Idr sepfl�
systems piing t to t tl�i sysf rr siiou c ;.Maliur�cti ®r tC�t �wnar is espial ib fog fg
rcessar t�paCrR'
3 i k c,;:c .'}. '"er.' a s •G X y + c r #+ "t . P 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 M 1S ' ' FROM If PART `O EPTt Y T
r.
D
NOT DRIVE OR PARIS ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist Date