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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME gcptv&,Vjj P(JAA," PHONE # 11gj' - Y6� -7jwj
ADDRESS
NAME OF MOBILE HOME PARK OI
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) 13 (o
7-b
Clan,
N . e 7/115-2b
PROPERTY LOCATION: STATE ROAD NAME AND #ar[.
)%O 5�
D I iJ
FcwIC4"a 4%t
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
i� Tt_Wtz l.lgt '/—Z I -
of Environmental Health Specialist Date