ETHTE# �38(¢& 6-
HARNETT COUNTY HEALTH DEPARTMENT
ENV]RONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME /;,S&hA,) lllft /49e6�z PHONE# f/4 G3S'379/i
ADDRESS : �Q r
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENI)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # '�L / sic) Ah I/ 3'.Cem
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 PARTOF SEPTIC SYSTEM:
Da NOT DRIVE OR PARK ON SEPTIC SYSTEM, ,
AUTHORIZATION OF EXISTING SYSTEM
.r is
5
of Environmental Health'Soecialist Date