ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME K ZdZo,J PHONE # -gljQ-/LXX
ADDRESS f y'/ �/��c1/1/DDlLe �=illi.[ /✓
NAME OF MOBILE HOME PARK OR S/D /6 7
NAME OF OWNER (IFDIFFERENT)
a
ADDRESS OF OWNER (IF DIFFERENT)
X757/
PROPERTY LOCATION: STATE ROAD NAME AND # -29-t /y7 S'
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,
\ a AUTHORIZATION OF EXISTING SYSTEM
Sig ture of Environmental Health Specialist Date