ETHTE#J -S-3781%
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME %c�{�/! J f ls.�� ✓o e-5 PHONE # Sl9- SS7- /B2
ADDRESS /Ze) AJoo&0(A4C4 D/L rV.
N.C.
7-7752(,
NAME OF MOBILE HOME PARK OR S/D
G)DF
Zf-
7
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #,�(Ly/7 GC.rosfi's„�li ��
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
DQNOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
,
of Environmental
V�,7-17N
Specialist
-28-1(p
Date