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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME -S 7 FGt%�//
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENI)
ADDRESS OF OWNER (IFDIFFEREN7)
PHONE# 91�- 5-8(.-Z' Z
PROPERTY LOCATION: STATE ROAD NAME AND #,�W /S-�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
BUILDING MUST BE 5 FROM ANY PART OF SEPTIC SYSTEM
bd NOT DRIVE OR PARK ON SEPTIC SYSTEM,
AUTHyO/R,IZAT/ION OF EXISTING SYSTEM
of Environmental Health Specialist Date