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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME �i } f C//S}„ , Lt%G PHONE #
ADDRESS -559 -J x.L4L r2b /Jjeyo AirI I /V• e//�� %i�S(� 2. r
NAME OF MOBILE HOME PARK OR S/D � kr/L P'/7 l J
NAME OF OWNER (IFDIFFERENI) (7l�jait'
ADDRESS OF OWNER (IFDIFFERENT)y�
PROPERTY LOCATION: STATE ROAD NAME AND # 15ryySZ 144
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 S' FROM ANY PART OF SEPTIC SYSTEM.
D NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION
of Environmental Health
SYSTEM
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Date