ETHTE# 557 3 i
DEPARTMENTHARNETT COUNTY HEALTH
ENVJRONMENTAL
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
PHONE #
r
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ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER r
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ADDRESS OF OWNER (IF DIFFEREN2) _80 -7
PROPERTY
r!. r. ,.: ,STATEROAD I
PURPOSE r rO .:
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
1 - �< r -
TO
i! f DRIVE OR PARK ON •
TIC S STEM
AUTHORIZATION OF EXISTING SYSTEM
/
Sig t re of Environmental Heath Specialist Date