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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ,JJ/f/l,, 'Ld PHONE#�L/ i 13G_'-�—% �f
ADDRESS i -7`) Piles t� fix '
NAME OF MOBILE HOME PARK OR S/D ! r / 4: -
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ?75?t 11N
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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 W; FRO
M W DRIVtOR
AUTHORIZATION
of Environmental Health
MPTIC SYSTEM_ ..
SYSTEM,
EXISTING SYSTEM
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Date