ETHTE# low -3'2jC5
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME J C4 L61-� RReA41fl RNC- PHONE # 5 ►U "'R9 -L- '317,-&
ADDRESS p� O • (3 o -v, --) 3 O f:y ri w oJ• C. • 1.363 3 y
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) -- —4—ADDRESS OF OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # 5+�C-7&-A> &,'9 IA14 UFS
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
Date