ETHTE# 1-7– : —tllS?P%
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 60 t"y �)C- Fbn: PHONE # / - 33(0 (SOY- 3SY8
ADDRESS Z" J=Y/AeiNoo iZb ✓=. V. N. C.
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ,JT;Sf
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
zdw� A -ZOKA (9-23-1-7
Sigl , t ire of Environmental Health Specialist Date