ET RHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAMEr .
i�,d�1►1 . 1 .. ' . ..
ADDRESS
NAME I
OF MOBILEHOME PARKO 1
NAME OF OWNER (IFDIFFEREN7)
ADDRESS I i
PROPERTY LOCATION: STATE ROAD NAME AND #
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
BUILDINGIMUS
T BE 5FROM• ,
RT OF SEPTIC'SYST'
EW
66NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
2 —,
of Environmental Health Specialist Date