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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME / �fi7j t )aS A Zs((s PHONE # _`j/Q 303 —3f367
ADDRESS /L,—J��G - P„,p 4„��.T�L. FV. N •L z-zr
NAME OF MOBILE HOME PARK OR S/DI�l�-U to ,�-t.�- / L{ 5 —
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFERENI)
PROPERTY LOCATION: STATE ROAD NAME AND # ZMj�17 f3,}t,� 2
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 Health Specialist Date