ETHTE# -S—39I�iS
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ' N,, }60>3 W,4IkA S PHONE # f/5, f1 +7 -325'f
ADDRESS �• O • S 2 llN 4�st� /`� - C . �15'� J
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
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