ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME .s r, aye PHONE #
ADDRESS y? a . _
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT) peF s P
ADDRESS OF OWNER (IF DIFFERENT) i 'LL
PROPERTY LOCATION: STATE ROAD NAME AND #
F
PURPOSE. OF INSPECTION,
~ ~,..eue_ve....~..3...-E„o-.~... :4 V' -~~.a.~i'~' .ehr rd~ s{'"'~.r~e1t '.✓G r'~,a r. tY t... .h_ ~.Y.'.r~w'r
S
ea
own
7
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 5f FROM ANYPARURSE
D0 NO DRIVE OR PARK ON SEPTIC S)
'(C SYSTEM
TER"`-
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date