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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME (Z, PHONE # 5— Uy�23
ADDRESS ®• r3c7X 2�s b e zAj •C 2..15 a 1
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NAME OF MOBILE HOME PARK OR S/D (~)r cQ- D
NAME OF OWNER (IFDIFFERENT) m f
ADDRESS OF OWNER (IFDIFFEREN7) 14 f tj )DA) t�S
PROPERTY LOCATION: STATE ROAD NAME AND # S"S
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 r
b6INOT DRIVE OR PARK ON •
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date