ETHTE#�7-�=- /5-Qa
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME' � � PHONE # !Z -TPJ
ADDRESS LD LJ C4,o2�Zr X- . o� A-1 r 7" .--n ,
NAME OF MOBILE HOME PARK OR S/D .a S j% (.& - N
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # b 1. G 5-3 Z
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�UTT/HORIZATION OF EXISTING SYSTEM
i re of Environmental Health Specialist Date