ETHTE# I(�-S 3 9013
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Odd wh.,v-� PHONE # 911- q2-2 "Sq(a�
ADDRESS X43 Ne-Q,-9,Q4�/� bUiynJ . N.c. 2833(
NAME OF MOBILE HOME PARK OR S/D 14-3�c (¢$ %
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7) 135T 0,f �C' i�y,.N n1.c.. 33y
PROPERTY LOCATION: STATE ROAD NAME AND # 25L /8o i 7, -o -^)1j
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 EXISTING SYSTEM
Environmental Health Specialist
-lip -
Date