ETHTE# J,57- 45- -3SZq:"`
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME /` /'Zdh ,,J PHONE # qi9
ADDRESS18� .5n c� t72 �• lU C 2-7;5 Z. G�
NAME OF MOBILE HOME PARK OR S/D _ �% { � �-r��,� (�j ��( (S () c6p
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # 6!1111/ G.r xz
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
BUILDINGMUST BE 5" FROM ANY PART OF SEOTIC'SYSTEM;
0 0 OT DRIVE OR PARK ON SEPTIC SY'
STEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health
H
pecialist
- Zo — /5
Date