ETHTE# 7_5
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME���� '� / PHONE # 87
ADDRESS
NAME OF MOBILE HOME PARK OR S/D kG'a5 cl"�
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ^ Jd2cv A�I
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 9 M`,FROM ANY PART OF SEPTIC SYSTEM_
00 NOT DRIVEOR PARK`ON'SEPTI'' SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date