ETHTE# /8-5- y355 y
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
ADDRESS Z25- J4
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PHONE # �/g-9OG'ZZO Z
C.
PROPERTY LOCATION: STATE ROAD NAME AND # may( /S57_
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
BUILOING MUST BB M+1100ANY PART bF SI
i DO' NOT DRIVE OR PARK Ott SEPTIC S
AUTHORIZATION OF EXISTING SYSTEM
of Environmental
SYSTEM -
3-Z3- i3
Date