ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME '���rU���CO.w( ,�r1rc it-.� PHONE #
ADDRESS 133T 15 u le a r,)iGz S i 1✓,� rf - c- . 7,93YY
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # �,t I R1( rr3ul 29
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
bd NOT DRIVE OR PARK ON SEPTIC SYSTEM -
of
AUTHORIZATION OF EXISTING SYSTEM
Health Specialist
Date