ETHTE# 1-7—:5"-- Z�S
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME V4 ?1+ —S C -V19' PHONE#.9,9 - �d F —ZS-32—
ADDRESS
ZS3Z
ADDRESS /9(9 %mJ
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) i4J 7,.4- IJP
ADDRESS OF OWNER (IFDIFFEREN7)%i✓ Ail
PROPERTY LOCATION: STATE ROAD NAME AND # Z7 F
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
$'--10— 11
of Environmental Health Specialist Date