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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ��(Lc, �,[� PHONE # *5- 7yp- 6,61P
ADDRESS -5-P,
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #/�0 3
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
BUILDIN -MUST BE5"FROM ANY
•,OF SEPTIC'SYSTEM,
-
DQ.'NOT DRIVE OR PARK.ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
re of Environmental Health Specialist Date