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HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME DAV�,� �,�,sC�p /�11r
/ PHONE# W 9 -4 S 7 X99
ADDRESSVd,c� t) C' ?r!
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) /�� f' /7 nlra %lI
ADDRESS OF OWNER (IF DIFFEREN7) 70 tf FA+t* 60
7
PROPERTY LOCATION: STATE ROAD NAME AND # �7t. /1l!rD 'aw
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
of Environmental Health Specialist
16-31-1-7
Date