ETHTE# I ( -t� -S f39 Z Z
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME /�/� r ` ��ll�� PHONEZ�—
ADDRESS j5 1% 3Ur� /.�G�i.� I % i /U 2 33� f
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # S -x.. i 73 i I
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.
y pQ` NOT DRIVE OR PARK ON SEPTIC SYSTEM,,,
AUTHORIZATION OF E�ISTING SYSTEM
F�
c Pf
of Environmental Health Specialist Date