ETHTE# 5-- 3 Lf 1 y 5—
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME
A) -A PHONE# 26s-1-075-
ADDRESS1a4�ru,/j,
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENI)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION STATE ROAD NAME AND # szo /,0 X'
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
-MUST BE 5" FROM ANY PART:OF SEPTIC'SYSTEM
BUILDING
M
DRIVE OR PARK ON SEPTIC SYSTE
N
AUTHORIZATION OF EXISTING SYSTEM'
2-
Health Specialist
Date