ETHTE# 7- S yZXZI
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE# 9/u-.S/Y-bql6
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #<5q -4Z 5 ` ,�e /✓ ��Jfy Q
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
bd NOT DRIVE OR PARK ON SEPTIC SYSTEM,
AUTHORIZATION OF EXISTING SYSTEM
N/�i r� jFFS lL-Y-I
of Environmental Health Specialist Date
J�