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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME f PHONE #
ADDRESS P-10.
NAME OF MOBILE HOME PARK OR r
NAME OF OWNER (IFDIFFERENI)
ADDRESS ,
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
s L ii !t
R. 911 it i C11 Z11 VA:111I 0117 toys *1K4
of Environmental Health Specialist
. 0�
Date