ETHTE #: 15-5-36103
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
Name: Danid Blackmon Phone #:
Address: 94 Blackmon Ln.
Name of Mobile Home Park or S/D:
Name of Owner (if different): Larada Blackmon
Address of Owner (if different):
Property Location (State Road name and #): Blackmon Ln
Purpose of Inspection: replace home
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
1 a 11
1. �.' 6.NO,
AUTHORIZATION OF EXISTING SYSTEM
CM
of Environmental Health Specialist Date