ETHTE# Ltl -5'-r-3S-6S'
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # &4- e/Z 7 .- Y
ADDRESS Z03d C Z7T&,0
NAME OF MOBILE HOME PARK OR S/D
CtgJ 2
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) t C r /V'Zsa
PROPERTY LOCATION: STATE ROAD NAME AND # J51/0 -
THIS
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
BUILDING7 MUST BE 5' FROM ANYPART OF SEPTIC'SYSTEM.
66NOT DRIVE OR " ON •'
AUTHORIZATION OF EXISTING SYSTEM
t
nature of Environmental Health Specialist
Date