ETHTE# I6 -S-385'4
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME vp /ZeCl>.N LlXe . PHONE # 336-307-- t/& g
ADDRESS %3 tL-oo� L (1 F -V • N • L. 7-712(,
NAME OF MOBILE HOME PARK OR S/D lm 3
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # fir(. /yt/Pn6 /(/J
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-
aO NOT DRIVE OR PARK ON SEPTIC SYSTEM' ;
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
S =3
Date