ETHARNETT COUNTY DEPARTMENT
ENVIRONMENTAL
307 CORNELIUSBOULEVARD
LILLINGTON,
EXISTING SEPTIC SYSTEM INSPECTION
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ADDRESS7<t-CA z ,., e ,
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OF MOBILE1 PARK OR fr
NAME OF 1 w�.
ADDRESS OF 1 F
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PROPERTY i 1 ROAD NAME AND #
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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
B1 ILDINGAUST. BE 5" FROM ANY PART'OF SEPTIC'SYSTEM,
ature of I
AUTHORIZATION OF EXISTING SYSTEM
Health Specialist
t
Date