ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME " L -),q- ,—cam 2'(% PHONE # 9,'5 - 5-7 4 - 7 ? Z(
ADDRESS /5:�-S1 01&t -,, - ih,-Yn. � Vl'� c
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) / A'4ke i
ADDRESS OF OWNER (IF DIFFEREN?)%(ate,- -. 4 �,/� o inti .c
PROPERTY LOCATION: STATE ROAD NAME AND # /,
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
r- r`�- Ll-. ; ,a i ee ,v
iig a ire of Environmental Health Speci list Date