ET RHTE# Z �i _ -- "7 Zd
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME �, PHONE #
ADDRESS
Z? /
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFERENI)
PROPERTY .O.
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
BUILDINGMUST.BE 5" FROM ANY PART OF SEPTIC"SYSTEM:
Dd NOT DRIVE OR PARK ON SEPTIC SYSTEM,!
AUTHORIZATION OF EXISATING SYSTEM
of Environmental health p�S ecialist
3 —2 -o-s
Date