ETHTE#~) YJL~3 -O -72
NAME ~~C~ rr
ADDRESS 110
PHONE # kf6)- C7yl~,
NAME OF MOBILE HOME PARK OR S/D 3c H ~ ~11
NAME OF OWNER (IFDIFFEREN7) (J,
ADDRESS OF OWNER (IF DIFFERENT) -72 771- a f i Nl
PROPERTY LOCATION: STATE ROAD NAME AND
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. N this system should-malfunction, the owner is responsible for a
any necessary repairs.
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 5' FROM ANY'PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
t,c ! i1 7 ZP' / k
of Environmental Health Specialist
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Date