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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 7`Yi tp r.J �i,� U PHONE # YN
ADDRESS
NAME OF MOBILE HOME PARK OR S/D OJT lkaAnaA:� z 4d .4V5
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # J5il YQ- rzn�G.v.
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
fHORIZATIONNOOFF,EXISTING SYSTEM
l�J.�a�
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of Environmental Health Specialist
3 -IV
Date