ET RHTE# /6 - 57- 3 3301Z.
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ?ZW /
ADDRESS is 2
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PHONE #/
PROPERTY LOCATION: STATE ROAD NAME AND # ck.1%0Q
IOkIL i_el rzkL
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 MUST BE T FROM ANY PART OF SEPTIC SYSTEM
y', D NOT DRIVEOR PARK ON SEPTIC SYSTEM,,,
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist Date