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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME <%f�.7�cr� /�CesSlld�/two PHONE #
ADDRESS _3y
NAME OF MOBILE HOME PARK OR S/D 5 -f
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # L-! 2,
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
-MUST BE 5" FROM ANY PART OF SE . PTIC"SYS'
BUILDING
TEM
DO; NOT DRIVE OR PARK ON SEPTI
C SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
s' -'t t5
Date