ETHTE# �_ 43�V60
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # 5'/O - %8`/-d/6
ADDRESS P-0 ed>O 7.597 r�+/u N•G. 'L8 $6z
NAME OF MOBILE HOME PARK OR S/D v, (-✓mac., � kl i. t 17-
NAME
z
NAME OF OWNER (IFDIFFEREN7) 1DA-� Sb:rroSa
ADDRESS OF OWNER (IFDIFFEREN7) 5 1 1�0 l (t f}yya ,J N • ?Sal
PROPERTY LOCATION: STATE ROAD NAME AND #c`AZ/5d6' l /LU
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 F,,'1, FROMANY PART OF SEPTIC SYSTEM:..
DONOT DRIi/E Ofd PARK ON SEPTIC SYSTEM,:,
AUTHORIZATION OF EXISTING SYSTEM
—1494f -S
of Environmental Health Specialist
g-?�& i
Date