ETHTE# i? -S --t/7.3o8
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME /y
_ n
ADDRESS i:7.
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PHONE# 210'150 -6103 -
PROPERTY LOCATION: STATE ROAD NAME AND # ST- 771 5'
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
BUILDINGMUST' BE 5' FROM ANY PART OF SEPTIC SYSTEMTLI :
{', aO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
�° /4
of Environmental Health 96ecialist Date