ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME J OSS �} S PHONE#
ADDRESS 3 SO C&ErIp (ti/J If- - 2 41%P V -Q - y N -C , 7 75
NAME OF MOBILE HOME PARK OR S/D �JtUnf T
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # -�5e, / 1((// -j /"
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
BUIL
of
B� 5' FROM ANY PART OF SEPI
�ST.
)T DRi' IE OR: PARK ON SEPTIC SYS'
)THORIZATI�OI, N OF EXISTING SYSTEM
I i
al Health Specialist
TEM:;
7
Date