ETHTE# /e-S-clyZ8Z
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME •
ADDRESS
.' . ;_-
NAME OF MOBILE HOME PARK OR
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREND
N
PROPERTY LOCATION: STATE ROAD NAME AND # f
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
AUTHORIZATION OF EXISTING SYSTEM
FIN
SYSTEM
of Environmenta(Health Specialist Date