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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME /� f� 6lZ/C�u S PHONE #'IxD-254 -2393
ADDRESS 'b , Q,3 -G /D-2 G—S /U .0 Z -75"Z/
NAME OF MOBILE HOME PARK OR S/D f30—IJ Low -o
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # 5---d5-63 ,;3%' L4 !± �^
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 MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM.
AUTHORIZATION OF EXISTING SYSTEM
of Environmental
Specialist
o^2& -/S "
Date