ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # ! "
ADDRESS
NAME OF MOBILE HOME PARK OR S/D to
G
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # �{
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" FAOMANYPARtOF SE'PTIC'SYSTEM
r i t i • PARK ONSEPTICSYSTE
AUTHORIZATIONOF EXISTING SYSTEM
apecianst