ETHTE# 1
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # 0-
i
ADDRESS
NAME OF MOBILE HOME PARK OR SID
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # I Z
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
00".00T DRIVE OR PARKON SEPTIC SYSTEM.
AUTHORIZATION OF EXISTING SYSTEM
A
re of Environmental Health Specialist
r
Date