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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
/JEXISTINGSEPTIC SYSTEM INSPECTION /
NAME "A!7-1dCOY ( ' PHONE #91%-1/6`(4'
ADDRESS A -
NAME OF MOBILE HOME PARK OR S/D��
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # 5X�t5Z6 /
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T�7 E� 1yf i1 7�.0
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
9UIL61N0- k 0 S f 98 5' FROM ANY PART SEPTIC SYSTEM
D,NOT DRIVE OR PARK ON SEPTIC. SYSTEM
AUTHORIZATION OF E ISTING SYSTEM
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of Environmen al Health Specialist Date