ETHTE# /-7-.5-- g611 il
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ZE 644-4aA oYv 15 PHONE #'919 3402
ADDRESS 382 4&dt,h -r�W>,) l..t) 4fOaS A)C. Z75ZI/
-r-
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # 5e&Z407�'��i�j
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 sin months
BUILDING MUSTBE 5' FROM ANY PART OF SEPTIC SYSTEM;
a0 NOT DRIVE OR PARK ON SEPTIC SYSTEM -
AUTHORIZATION OF EXISTING SYSTEM
--�e-' /7' 3-14-1
of Environmental Health Specialist Date