ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ,6 18 C le'a W PHONE # T/0-5-9/-97,?7
ADDRESS 1ZI 4ZA-j6f,— rtk /V,C- i?5"z/(„
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT) Lt i- (Ave 4Ij2(e� t�
ADDRESS OF OWNER (IF DIFFERENT) 13
PROPERTY LOCATION: STATE ROAD NAME AND # -45-Ui/Ql ( GE9,y,�yc�
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.
Da' NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZA'
OF EXISTING SYSTEM
of Environmental Health Specialist Date