ETHTE# rg - -5--- 370 Sy
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME dl.&) $ G6{X$-K PHONE # 9/5 -16,Q -575Z
ADDRESS 34-7 IV Z 7
NAME OF MOBILE HOME PARK OR S/D - _��,� 1 �G S /7
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #,64W yQ/ itI
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
r
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
D6 NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
4)— ZZ --r 5,
of Environmental flealth Specialist Date