ET RHTE# - S - 33s" i 2
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ' �+--o } 42e �s, a- Gu ar PHONE # 33r�' - 302 - V (61 *7
ADDRESS i 3 17.4 F- V , N •r-- Z -7s -
NAME OF MOBILE HOME PARK OR S/D 5�6-T3d-o-J " Ls-+ 3
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # &r, IVIS -`Z" 64VIe64--,C
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
of Environmental Health Specialist
6 - Z—(
Date