ETHTE# 18 �-43i 1
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME �f�56 �n oc� Cls^ ,u.��� L PHONE# _ 01q— yZ3T
ADDRESS 23Z3 "4-DY7(1,k J24) – IV G Zig fCo 2
NAME OF MOBILE HOME PARK OR S/D mayy_ /�LJZ1� J
NAME OF OWNER (IFDIFFEREN7)�
ADDRESS OF OWNER (IFDIFFEREN7) 4-9 r6 /g&'-) 4�e�,f -r, Oa. Z�UNi�J I J c
PROPERTY LOCATION: STATE ROAD NAME AND # Pf �4 cf Z/(
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
EP.TIC YSTEI
�YSTPM
AUTHORIZATION OF EXISTING SYSTEM