ETHTE# /s - -
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME a PHONE # ®
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ADDRESS
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2 _ _, 77- >��J ,y , 2,7sz, t
NAME OF MOBILE HOME PARK OR S/D
NAMEOF OWNER (IFDIFFERENY)
ADDRESS OF OWNER (IFDIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # zZLC 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
BUI,LDINGMUST BE 5" FROM AN. PARTOF SEPTIC SYSTEM:
DQNOT DRIVE OR PARK ON SEPTIC SYSTEM
re of I
AUTHORIZATION OF EXISTING SYSTEM
Health Specialist
Date