ET RHTE# 11-1--x: 3` 8
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION`
NAME ' L' a C�� t: �- I P ONE # 9/j °'/90 ° 05 -7 3
ADDRESS Z1 Z V L' % iL+e�- N > C
NAME OF MOBILE HOME PARK OR S!D
NAME OF OWNER (IF DIFFERENT)
a
ADDRESS OF OWNER (IFDIFFERENT) 3S-7 04-cP. �3
PROPERTY LOCATION: STATE ROAD NAME AND # - r•%b�ts 7 t� r 5{a�g a '
PURPQSE U'INSPECTION
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iii
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
0F SEPTIC'SYSTEM
wr� BUILDINGAUST BE 5' FROM ANY PART
DQ,NOT DRIVE OR PARK ON •
AUTHORIZATION OF EXISTING SYSTEM
I Ore of Environmental H alth Specialis Date