ETHTE #: 13 -5 -32400
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Jefferey Bruce Phone #: 919 - 639 -5511
Address: 44N Broad St. E Angier NC 27501
Name of Mobile Home Park or S /D:
Name of Owner (if different):
Address of Owner (if different):
Property Location (State Road name and ft NC55
Purpose of Inspection: Motorcycle Roair Sho]2.(4 Employes)
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. If the system should malfunction, the owner is responsible for 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 change, and /or
4. after six months
11 INS DKII 11A 6LIVINIwelm 01 W I res
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environmenta-1 He' h Specialist