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BARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME L/,(tp ('o 2k Ze ee&Lrr aZ PHONE # S'/S -ZrL5'-
ADDRESS Sit C..i fty.ei,.,_ fcb �e,-a ,V C 275FD7
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENI)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 5;t 1o06 p /,fA,- )ZA
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 BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO.NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF E ISTING SYSTEM
g ature of Environmental Health Specialist Date