ETHTE# 1'5 - t - -7`7
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Z .L✓. „� PHONE # 91q --! ZI- 6Z
ADDRESS ifs ✓ Je hie IV, C,
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # r
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
-MUST. BE 5FROM ANY PART OF SEPTIC'SYSTEM:
BUILDING
1� DQNOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
" nature of Environmental Hea th Specialist Date