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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 7g"' �,J� PHONE # g/ 4 - 00ZO -631r5'
ADDRESS Tn W % q-tt-� j2,j '�tj N, C_. 2-e6 3 q
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENI)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND /J j FST-%
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
00 NOT DRIVE.OR'PAkI( Off SEPTIC SYSTEM. ,
AUTHORIZATION OF EXISTING SYSTEM
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Date
01