ETHTE# 11—$ =tq 2-QZS
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME (12 PHONE #p/aj-Z�S=(fl/83
ADDRESS [U / 5 �� f� /� e ic-.r o, 2 A)a Z7:0/
NAME OF MOBILE HOME PARK OR S/D A)
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # -a� � (/tn
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