ETHTE# V0g571
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME � �L/ - �� J/�� ` PHONE # 1nlU — 72 q — IS 3
ADDRESS 107 N • Z 3Q
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #31 / 775-/Isk- 1&e-
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-
. , a0`NOT DRIVE OR PARK ON SEPTIC SYSTEM
f AUTHORIZATION OF EXISTING SYSTEM
of Environmental H alth Specialist Date