ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ' •�j i t PHONE #
ADDRESS -F� b - 6cX (3 ,c3S" e6)+-'L-5
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
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Wo 411
rt t r�x i f k ti(aaa � t�A l, n1 x i.+ n 6� e t t i„ s f �6-� D
s bl e':' n qpt�a"....... m,ti�1n 'j ee n �' y i
res onsi��e fog.
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
5igt re of Environmental Health Specialist Date