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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME /`W f� �1 %c� �C PHONE #
ADDRESS /U
NAME OF MOBILE HOME PARK OR S/D
v U
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #
THIS INSPECTION IS VOID IF. -
(1)
F:(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
BUILDINGMUSTFROM - OF
EM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM:
AUTHORIZATION OF EXIST NG SYSTEM
of EnvironmentafHealth Specialist
Date