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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
PHONE# 5W2-625:7-
NAME
W%—G2S:
ADDRESS
NAME OF MOBILE HOME PARK OR S/D /,���}��1(�5v/��G/tel/
NAME OF OWNER (IFDIFFERENT) O c � i- z
ADDRESS OF OWNER (IFDIFFEREN7) O�—, tl� AJ, C
PROPERTY LOCATION: STATE ROAD NAME AND # _.1Y.5 (P &;mac % 4
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
BUILtiING ,MUST 815 5' FROM ANY PART Of= SE
D0`NOT DRIVE 0 R PARK 0NSEPM S
AUTHORIZATION OF EXISTING SYSTEM
SYSTEM
M
of Environmental ITealth Specialist Date