ET to show proof of 4th bedroom approvalHTE# 4, 3 _ 5-35-6
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME G.f'k < kW)te4-b PHONE #
ADDRESS 1,1-1-7 Y1yz 0M. -Rd. — (�milS lv e�
NAME OF MOBILE HOME PARK OR S/D COXCt_
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STAT O D N ME ND # � ���`3
-eD T
'PURPOSE. OF INSPECTION ,Q . X� n94) 1 U�ij
x TL=i�!`�i��:''�t'?k`y'lt`.�3�•'., > 3a�F .n.r "
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
s , DO NOT DRIVE OR PARK ON SEPTIC SYSTEM"
AUTHORIZATION OF EXISTING SYSTEM
it' C�7.rJa rte. i V15 / _7 --
Health
Health Specialist Date