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HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, 46
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE# _ :♦
ADDRESS. • i� > s�
NAME OF MOBILE HOME PARK OR S/D
r � f
NAME OF OWNER
ADDRESS OF OWNER ,
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
BUILDING FROM 1: • •TrOF SEPTI
OT V OR EPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
re of Environmental Health Specialist