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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
ADDRESS I ,I ... ;ah,,.rj5_moi• .1 '
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENI) Zot�,R�/
PROPERTY LOCATION: STATE ROAD NAME AND #
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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
BUILDINGMUST BE 5 FROM ANY PART OF SEPTIC SYSTEM
DNOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
mfg"re of Environmental Health Specialist Date