ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # I s
ADDRESS f C
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
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
BUILDINGMUST BE 5. FROM ANY PARTOF SEPTICSYSTEN,
DO'NOT i DRIVE i''PARK ON •
TIC SYSTEM.'
AUTHORIZATION OF EXISTING SYSTEM
® —rs
Si ure of Environment Hea th Specialist Date