ETHTE#— =
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAMELt
PHONE # _ S l g `l DCS
ADDRESS S�®g 5� ✓ to N y� z—�
NAME OF MOBILE HOME PARK ORS/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFERENT) 110 1,11CIESc �`� F : y'. /V G
PROPERTY LOCATION: STATE ROAD NAME AND # Y2 x _)
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 Y
KNOT DRIVE OR PARKON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Siy� ure of Environmental Health Specialist