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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME y0LePHONE # 2/0i- W7 - ((333
ADDRESS $0 eA /Z a-*egr > �OC 1VyVXe- /U, C. 7,76-0 /
NAME OF MOBILE HOME PARK OR S/D A
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #1ISMO
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
of Environmental Health Specialist
12-30--16
Date