ETHTE# f s - 5--36/75
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME
PHONE # ` 1 '� -20
ADDRESS Z-7 2-
NAME
NAME OF MOBILE HOME PARK OR S/D
OWNERNAME OF
ADDRESS
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
BUIPIN47MUST BE 51-� •,;DQ' NOT DRIVE OR PARK ON SEPTICMTEM.,
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist
Date