ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME / /d Al-rS U l%/fn)
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
PHONE # 9l9-337—eg57
NAME OF OWNER (IF DIFFERENT) 4zp'� /)? 'r J
ADDRESS OF OWNER (IFDIFFERENT) 7i`7 ?,0
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
OO' NOT DRIVE OR PARK ON SEPTIC SYSTEM,
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist Date