ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE #
ADDRESS
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)
F:(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
DI ; -# -EWOT DRIVE OR PARK ON SEPTIC SYSTEW"
AUTHORIZATION OF
of Environmental Health Specialist
7 -
Date