ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 6v -r1>062. &:L'A� PHONE # '5®v -"6 3TI 3
ADDRESS -7i q 9V Z -x
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)'
ADDRESS OF OWNER (IFDIFFEREN7) 13
PROPERTY LOCATION: STATE ROAD NAME AND # rZ pS
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
1'RT OF SEPTIC'SYSTEM,
- •,TEDQNOT DRIVE OR PARKON SEPTIC', SYS
AUTHORIZATION OF EXISTING SYSTEM
-Sig It re of Environmental Health Specialist Date