ETHTE# JS = - 31 %4L
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # 9/°i-G3Z- Z4F
ADDRESS
NAME OF MOBILE HOME PARK OR S/D /NearAa,,>/�,c�yr lad- Q,_
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND /5/3 A)r - s Cjetk OeN
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
BUILDING MUSTBE 5` FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM '
AUTHORIZATION OF EXISTING SYSTEM
, /D-ZZ—/5�
re of Environment l Health Specialist Date