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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # Ti 9 -z7l — MI6 `l 1
ADDRESS 1 Ste' J L.V, //// l3 • E • 7i�S'2 ( e -,NAME OF MOBILE HOME PARK OR S/D V.—z d 6:ILC dL
NAME OF OWNER (IFDIFFERENI)
ADDRESS OF OWNER (IFDIFFEREN7)
l yy�
PROPERTY LOCATION: STATE ROAD NAME AND # 5t C/Y�p & /"U�
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 WST BE 5' FROM ANY PART OF SEPTIC SYSTEM:.
3 , Dq NOT DRIVt OR PARK ON'SEPTIC SYSTEM
AUTHORIZATION OY EXISTING SYSTEM
of Environmental Health Specialist
—3o
Date