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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # 5-18- &D - �7
ADDRESS ZIS
NAME OF MOBILE HOME PARK OR S/D 5 * la
NAME OF OWNER (IFDIFFER,ENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND #
PURP,QSI QI'FNSPECTION °
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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 Ei TtC S STEIVf
DO NOT DRIVE OR PARK ON: SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM