ET RB
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME I PHONE # -
ADDRESS 108 , r 1 Z-7
INAME OF MOBILE ,.
RK OR S/D
NAME OF OWNER ,
ADDRESSOWNER ,
r"ROPERTY LOCATION:.O., NAME AND'#
r 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
BUILDINGAUST BE 5" FROM AN 'OF SEPTIC'SYSTEM:
Y PART
DQ'NOT DRIVE OR PARK ON SEPTIC SYSTEM.
AUTHORIZATION OF EXISTING SYSTEM
® A
of Environmental Health Specialist
Date