ETHTE# �b'-�- (e30
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME J�, I PHONE # 515'-46 5 // 76
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #!�j% -21&S S
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 MUSTBE 5' FROM ANY PARTOPSEPTIC SYSTEM:;.
00", OT DRWOR PARK ON SEPTIC SYST9 ;
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist Date