ETHTE# - 2618
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME /L J~ PHONE # ; -
o ~
ADDRESS
NAME OF MOBILE HOME PARK OR S/D Z ,-c_ z / ~;,~L~ s d-i-
/
NAME OF OWNER (IFDIFFERENT)~
ADDRESS OF O'"NER (IFDIFFERENT) j-) 15
PROPERTY LOCATION: STATE ROAD NAME AND # r
PURPOSE OF INSPECTION: Iy z-/
l
The aforementioned site has been eval' uated byte arnett-Coun~ealth Department.
Environmental Health Section. At the time of inspection, there appeared to be a septic''
system serving this site. If this 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 changes, and/or
(4) after six months
BUILDING MUST BE 5r FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AtTTHORIZATION OF EXISTING SYSTEM
7
Signature of Environmental Health Specialist
Date