ET RHTE# 1 ,3
COUNTYHARNETT ,. ,
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME', _
U PHONE #
ADDRESS / 3 l
NAME OF MOBILE HOME PARK OR S/D c
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
FRom ANY.,
RTbF SEPTIC'
BUILDING
PARK N
DQ NOT DRIVE OR 0 SEPTIC SYSTEM,
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
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